Postoperative pain treatment with transmuscular quadratus lumborum block and fascia iliaca compartment block in patients undergoing total hip arthroplasty: a randomized controlled trial

Qin Xia,Chao Lin,Jiayi Xia,Wenping Ding,Mengxing Jia,Yahui Xu

doi:10.1186/s12871-021-01413-7

Abstract

BackgroundPatients often suffer moderate or even severe pain after total hip arthroplasty; such pain seriously affects early postoperative recovery. This study aimed to investigate the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block combined with fascia iliaca compartment block for elderly patients undergoing total hip arthroplasty.MethodsFifty-four patients scheduled for total hip arthroplasty were included in this randomized controlled study. The patients were randomly assigned to receive only transmuscular quadratus lumborum block (group Q) or transmuscular quadratus lumborum block combined with fascia iliaca compartment block (group QF) with ultrasound guidance. Postoperatively in both groups, paracetamol 1 g was regularly administered at 6 h intervals and patient-controlled intravenous analgesia was administered. The primary outcome was cumulative sufentanil consumption via patient-controlled intravenous analgesia 24 h postoperatively. The secondary outcomes included pain degree, time to the first analgesic requirement, joint range of motion, quality of recovery, and the incidence of postoperative complications.ResultsFifty patients were included, and their data were analyzed. The cumulative sufentanil consumption in group QF was significantly lower during the first 24 h after surgery than that in group Q, and the cumulative sufentanil consumption in group QF was reduced at 6–12 and 12–18 h after surgery. The postoperative pain intensity was lower in group QF than in group Q (linear mixed-effects model, the main effect of treatment: P < 0.001). Compared with group Q, group QF had higher quality of recovery and joint range of movement. The time to the first analgesic requirement was longer in group QF than in group Q (log-rank, P < 0.001). There was no statistically significant difference in complications postoperatively between the two groups.ConclusionsOur study provides a multimodal, opioid-sparing analgesic regimen for elderly patients undergoing total hip arthroplasty. The combination of transmuscular quadratus lumborum block and fascia iliaca compartment block provides a significant advantage for early postoperative functional recovery. Further studies are required to confirm the minimum effective dose.Trial registrationThe study was registered on the 21st December 2020 (retrospectively registered) on the Chinese Clinical Trial Registry: ChiCTR2000038686.

Highlights

Patients often suffer moderate or even severe pain after total hip arthroplasty; such pain seriously affects early postoperative recovery
The cumulative sufentanil consumption was reduced by roughly one-third when patients were receiving transmuscular quadratus lumborum block (T-QLB) combined with Fascial iliac compartment block (FICB)
54 subjects were included and randomly assigned to receive either T-QLB (n = 27) or T-QLB combined with FICB (n = 27)

Summary

Introduction

Patients often suffer moderate or even severe pain after total hip arthroplasty; such pain seriously affects early postoperative recovery. Total hip arthroplasty (THA) is the common method to treat severe hip diseases and reconstruct joint function; the incidence and degree of postoperative pain are closely related to postoperative cardio-cerebrovascular complications and early postoperative recovery quality [2, 3]. PROSPECT 2010 guidelines recommend various approaches, such as intravenous analgesia, epidural analgesia, local anesthetic infiltration techniques, and peripheral nerve block (PNB), that aim to minimize THA perioperative pain in elderly patients [5]. Postoperative pain management and minimization of opioid administration remain the primary perioperative challenges for elderly patients [6]

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