QL Block for Postoperative Pain in Hip Surgery

Overseen By Pamela Chia, MD

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: University of California, Los Angeles

Must not be taking: Opioids

Disqualifiers: Peripheral neuropathy, Coagulopathy, others

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: Immediate perioperative period

80 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a pain relief method called the quadratus lumborum (QL) block for individuals undergoing hip replacement surgery. Researchers aim to determine how effectively this method reduces post-surgery pain compared to a saltwater solution. The trial includes two groups: one receiving the QL block with a pain reliever and another receiving a saltwater injection for comparison. It suits adults planning hip replacement surgery who are not allergic to local anesthetics and do not use opioids regularly. As an Early Phase 1 trial, this research focuses on understanding the QL block's effects in people, offering participants the chance to be among the first to experience this innovative pain relief method.

Do I need to stop taking my current medications for the trial?

The trial information does not specify if you need to stop taking your current medications. However, if you are using opioids regularly, you may not be eligible to participate.

What prior data suggests that the quadratus lumborum block is safe for postoperative pain management in hip surgery?

Research has shown that the quadratus lumborum (QL) block, particularly with ropivacaine, is generally safe. Studies have found that QL blocks effectively relieve pain after hip surgery, with no major safety issues reported. One analysis demonstrated that QL blocks provided significantly better pain relief compared to not using a block or using a placebo.

Another study found that older patients who received QL blocks experienced better recovery after hip surgery. The QL block is considered a promising method for managing pain in these surgeries. Although this trial is still in the early stages, existing evidence suggests that QL blocks are well-tolerated. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the quadratus lumborum (QL) block for postoperative pain in hip surgery because it offers a new approach to pain management that specifically targets the nerves in the lower back. Unlike standard treatments such as opioids or epidural anesthesia that can have widespread effects on the body, the QL block uses ropivacaine, which is injected directly near the quadratus lumborum muscle to provide targeted pain relief. This method has the potential to reduce the reliance on systemic pain medications, minimizing side effects and enhancing recovery. By directly addressing pain at its source, the QL block could lead to more effective and efficient pain control after hip surgery.

What evidence suggests that the QL block is effective for postoperative pain in hip surgery?

Studies have shown that a quadratus lumborum (QL) block with ropivacaine effectively reduces pain after hip surgery. In this trial, participants in the intervention group will receive the QL block with 0.25% ropivacaine. Specifically, patients who received this block used about 15.78 mg less opioid medication in the first 24 hours after surgery compared to those who did not receive it. Research also indicates that the QL block provides longer-lasting pain relief. In hip surgeries, patients who had a QL block reported less pain and needed fewer painkillers immediately after the operation. These findings suggest that the QL block could improve pain management for people undergoing hip replacements. ^{1 2 6 7 8}

Who Is on the Research Team?

Pamela Chia, MD

Principal Investigator

University of California, Los Angeles

Are You a Good Fit for This Trial?

This trial is for adults having elective primary total hip arthroplasty. It's not suitable for those under 18, with allergies to local anesthetics, peripheral neuropathy, long-term opioid use, or conditions that contraindicate spinal and regional anesthesia like coagulopathy or site infections.

Inclusion Criteria

I am an adult scheduled for my first total hip replacement surgery.

Exclusion Criteria

I cannot have spinal or regional anesthesia due to a bleeding disorder or an infection.

I experience numbness, tingling, or pain in my hands or feet.

I am under 18 years old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a quadratus lumborum nerve block with either ropivacaine or saline during primary total hip arthroplasty

Immediate perioperative period

1 visit (in-person, surgical procedure)

Postoperative Monitoring

Pain scores and opioid usage are assessed over the first 48 hours after surgery

48 hours

Follow-up

Participants are monitored for patient satisfaction, time to ambulation, and other recovery metrics until discharge

Up to 1 week post surgery

What Are the Treatments Tested in This Trial?

Interventions

• Quadratus Lumborum Block

Trial Overview The study tests the effectiveness of Quadratus Lumborum (QL) blocks in managing pain after hip replacement surgery. Participants will be randomly assigned to receive either the QL block (active comparator) or a placebo.

How Is the Trial Designed?

Group I: Intervention Group Active Control 1 Intervention

Quadratus lumborum nerve block with 0.25% ropivacaine

Group II: Control Group Placebo Group 1 Intervention

Quadratus lumborum nerve block with saline

Who Is Running the Clinical Trial?

University of California, Los Angeles

Lead Sponsor

Trials

1,594

Recruited

10,430,000+

Published Research Related to This Trial

In a study of 80 patients undergoing total hip arthroplasty, the quadratus lumborum (QL) block significantly reduced pain scores and opioid consumption for up to 48 hours post-surgery compared to a control group without the block.

Patients receiving the QL block reported higher satisfaction scores, indicating that this technique not only provides effective pain relief but also enhances the overall patient experience after surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Kukreja, P., MacBeth, L., Sturdivant, A., et al.[2021]

The quadratus lumborum (QL) block significantly reduces opioid consumption by approximately 15.78 mg in the first 24 hours after hip surgery compared to placebo or no block, indicating its efficacy in postoperative pain management.

Patients receiving the QL block reported a reduction in pain during movement, with a pain grade decrease of 2.95 compared to those who did not receive the block, suggesting improved analgesia without affecting static pain scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery. Xiong, H., Chen, X., Zhu, W., et al.[2022]

The ultrasound-guided quadratus lumborum (QL) block significantly reduced pain during mobilization and opioid consumption at 48 hours post-hip arthroplasty, showing clinical significance compared to the non-QL block group in a meta-analysis of 11 trials with 830 patients.

The QL block also improved patient satisfaction and reduced the incidence of postoperative nausea and vomiting, although its impact on pain at rest and opioid use at earlier time points did not reach minimal clinically important difference (MCID).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Ultrasound-Guided Quadratus Lumborum Block for Postoperative Analgesia After Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. Hu, Z., Zhang, Z., Tian, X.[2023]

The anterior quadratus lumborum block (QLB) significantly reduces the need for opioid analgesics and lowers postoperative pain scores in patients undergoing total hip arthroplasty, indicating its efficacy in pain management.

The QLB technique is safe and does not result in lower limb muscle weakness, making it a favorable option for postoperative pain control after hip surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-Guided Oblique Sagittal Anterior Quadratus Lumborum Block in Total Hip Arthroplasty: A Randomized Controlled Trial. Wang, N., Ruan, B., Wang, M., et al.[2022]

The quadratus lumborum (QL) block technique, used in two patients undergoing total laparoscopic hysterectomy, significantly reduced the need for opioids during the perioperative period and improved pain management in the first 24 hours post-surgery.

Both patients reported high satisfaction with their pain relief, suggesting that QL block could be an effective component of multimodal analgesia for laparoscopic surgeries, although more research is needed to optimize its application.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-guided anterior and posterior quadratus lumborum block for analgesia after laparoscopic hysterectomy. Singh, N., Rao, PB., Elayat, A.[2021]

In a study of 50 patients undergoing hip replacement surgery, the transmuscular quadratus lumborum (TQL) block did not result in lower opioid consumption compared to the fascia iliaca block (FIB) within the first 24 hours post-surgery.

Both TQL and FIB provided similar pain relief and motor function outcomes, indicating that TQL may not offer additional benefits over FIB when used with spinal anesthesia in this context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transmuscular Quadratus Lumborum Block versus Infrainguinal Fascia Iliaca Nerve Block for Patients Undergoing Elective Hip Replacement: A Double-blinded, Pilot, Randomized Controlled Trial. Hashmi, J., Cusack, B., Hughes, L., et al.[2022]

The quadratus lumborum (QL) block is an effective postoperative analgesic technique for major laparotomy, resulting in low pain scores and reduced opioid consumption on the first day after surgery.

This method provides sensory block up to the T8-L1 levels, indicating its potential for effective pain management in abdominal surgeries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. Kadam, VR.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9118859/

Postoperative analgesic effectiveness of quadratus ... QL block reduced the opioid use by 15.78 (95% CI, 2.31 to 29.26) mg IME in the first postoperative 24 h compared with no block or placebo with ...

2. bmcgeriatr.biomedcentral.com bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-04514-9

Effects of anterior approach to quadratus lumborum block on ... This study aimed to assess the effects of the anterior approach to QLB on postoperative cognitive function in older people undergoing hip ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0104001425000983

Comparison of three Quadratus lumborum block ... Anterior approach to QL block reduces post operative analgesic consumption and provides longer duration analgesia with better parental ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT04402437

QL vs LP Blocks for Analgesia Following THA The quadratus lumborum block is already a block utilized for a variety of surgical procedures to decrease postoperative pain. Potential benefits to the QL block ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6206687/

Quadratus lumborum block provides improved immediate ... Hip arthroscopy patients who received a preoperative QL block had less pain and a lower opioid requirement in PACU than those who did not receive a block.

6. cureus.com cureus.com/articles/388070-quadratus-lumborum-block-the-new-gold-standard-in-abdominal-analgesia

Quadratus Lumborum Block: The New Gold Standard in ... This review finds that QLB offers considerable benefits for abdominal analgesia, making it a novel and promising technique for standardizing ...

7. arthroscopyjournal.org arthroscopyjournal.org/article/S0749-8063(21)00807-0/fulltext

Editorial Commentary: Quadratus Lumborum Analgesia for ... Quadratus lumborum (QL) nerve block is a new technique aimed to improve perioperative analgesia for patients undergoing hip arthroscopy.

8. epain.org epain.org/journal/view.html?uid=1821&vmd=Full

Postoperative analgesic effects of the quadratus lumborum ... Background: This study assessed the postoperative analgesic efficacy and safety of the quadratus lumborum block (QLB) in pediatric patients.