Transmuscular Quadratus Lumborum Block Does Not Provide Significant Benefit for Primary Hip Arthroscopy with Pericapsular Infiltration: A Randomized Control Trial

Abstract

To prospectively evaluate the effectiveness of the transmuscular quadratus lumborum block (TQLB) with pericapsular injection (PCI) versus PCI alone in patients undergoing hip arthroscopy for treatment of femoroacetabular impingement (FAI) in terms of perioperative pain control, as well as postoperative function in the postoperative anesthesia unit (PACU) setting. Patients undergoing hip arthroscopy for FAI were prospectively randomized to receive 30 mL of 0.5% bupivacaine in a TQLB (n= 52) with PCI versus PCI alone (n= 51). The PCI included 20 mL of 0.25% bupivacaine given by the surgeon. All analyzed patients received general anesthesia. The primary outcome was postoperative pain scores assessed via the numerical rating scale (NRS) at 30 minutes postoperatively and immediately prior to discharge. Secondary outcomes were opioid utilization, expressed as morphine milligram equivalents (MMEs), PACU recovery time, quadriceps strength (assessed after completion of PACU phase 1 criteria), and adverse events (nausea/vomiting). Average age, body mass index, and preoperative pain assessment were not significantly different between groups. There were no differences in NRS pain scores preoperatively, 30 minutes postoperatively, or immediately prior to discharge between groups (P > .05). Intraoperative opioid consumption was significantly lower in the TQLB group (MME: 16.8 ± 7.9) compared to controls (MME 20.6 ± 8.0; P= .009). However, there was no difference in the total opioid consumption (P > .05). There was no significant difference in total PACU length of stay (minutes) between the treatment (133.0 ± 48) and control groups (123.5 ± 47; P > .05). Quadriceps weakness was not significantly different between groups (P= .2). There was no difference in the number of patients that experienced nausea or vomiting between the TQLB group and control group (13% vs 16%; P= .99). Neither group had any reported serious adverse events. TQLB and PCI do not improve postoperative pain scores or total opioid consumption compared to PCI alone. TQLB may decrease the amount of intraoperative opiate usage. Level I, randomized controlled trial.