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

Trial Summary

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 data supports the effectiveness of the treatment Quadratus Lumborum Block for postoperative pain in hip surgery?

Research shows that the Quadratus Lumborum Block is effective in reducing pain after hip surgery, as it provides better pain relief compared to no block or other pain management techniques. Studies have found it to be beneficial in managing pain after hip arthroplasty, with patients experiencing less need for additional pain medication. ^{1 2 3 4 5}

Is the QL Block safe for humans?

The QL Block, used for pain relief after surgeries like hip replacements, has been studied in various forms and is generally considered safe. It is a regional anesthetic technique that has been used effectively without major safety concerns reported in the studies. ^{1 2 3 6 7}

How does the QL block treatment differ from other treatments for postoperative pain in hip surgery?

The QL block is a novel regional anesthetic technique that provides pain relief by targeting specific nerve branches in the lower back, which can reduce the need for opioids and minimize muscle weakness compared to other pain management methods. ^{1 2 3 4 5}

What is the purpose of this trial?

The quadratus lumborum (QL) block is a fascial plane block that has been described to provide analgesia from T7-L3 dermatomes. The investigators aim to evaluate the efficacy of QL blocks in patients undergoing primary total hip arthroplasty (THA).

Research Team

Pamela Chia, MD

Principal Investigator

University of California, Los Angeles

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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 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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. [2021]

3. United States 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. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Ultrasound-Guided Oblique Sagittal Anterior Quadratus Lumborum Block in Total Hip Arthroplasty: A Randomized Controlled Trial. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Ultrasound-guided anterior and posterior quadratus lumborum block for analgesia after laparoscopic hysterectomy. [2021]

6. India pubmed.ncbi.nlm.nih.gov

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

7. New Zealand 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. [2022]