Quadratus Lumborum vs Erector Spinae Blocks for Postoperative Hip Surgery Pain

Overseen By ROLAND BRUSSEAU, MD

Age: < 65

Sex: Any

Trial Phase: Phase 4

Sponsor: Boston Children's Hospital

Must not be taking: Opioids

Disqualifiers: BMI > 35, Coagulopathies, Neurodevelopmental delays, Chronic pain, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 12

Duration: 3 days

156 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial is comparing two types of nerve blocks, ESB and QLB, used with a lumbar plexus block to manage pain in young patients after hip surgery. The goal is to see if there is any difference in pain relief and opioid use between the two methods. Both blocks aim to reduce pain by numbing specific nerves, potentially lowering the need for opioids. Quadratus lumborum block (QLB) has been increasingly used for pain control following hip surgeries, showing effectiveness in reducing postoperative pain and opioid consumption.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you have been treated with opioids in the last 2 months, you may not be eligible to participate.

What data supports the effectiveness of the treatment Erector Spinae Block and Quadratus Lumborum Block for postoperative hip surgery pain?

Research shows that both Erector Spinae Plane Block and Quadratus Lumborum Block have been effective in reducing pain after various surgeries, including hip and femur operations, caesarean sections, and abdominal surgeries. These treatments help manage pain by blocking nerve signals in specific areas of the body. ^{1 2 3 4 5}

Is it safe to use Quadratus Lumborum and Erector Spinae Blocks for pain relief after surgery?

Research studies have used Quadratus Lumborum and Erector Spinae Blocks in various surgeries, such as abdominal and hip surgeries, and have generally found them to be safe for providing pain relief after surgery. ^{1 2 3 4 5}

How do Quadratus Lumborum and Erector Spinae Blocks differ from other treatments for postoperative hip surgery pain?

Quadratus Lumborum and Erector Spinae Blocks are unique because they are types of nerve blocks that target specific areas in the back to provide pain relief after surgery. Unlike general pain medications that affect the whole body, these blocks work by numbing the nerves around the surgical site, potentially offering more targeted and effective pain control with fewer side effects. ^{1 2 3 4 6}

Research Team

ROLAND BRUSSEAU, MD

Principal Investigator

Boston Children's Hospital

Eligibility Criteria

This trial is for young individuals aged 15-30 with developmental acetabular dysplasia experiencing hip pain, who are undergoing unilateral hip surgery. They must be in good health (ASA I - III status) and not overweight (BMI ≤ 35). Those with blood clotting issues, severe neurodevelopmental delays, chronic pain syndromes, recent opioid use, or without parental/patient consent are excluded.

Inclusion Criteria

I am having surgery for hip dysplasia and my health is relatively good.

I am between 15 and 30 years old.

Exclusion Criteria

Lack of parental consent and/or patient assent.

I have been treated with opioids in the last 2 months.

I am having surgery to correct my hip, including adjustments or hip replacement.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either a single-shot erector spinae block or quadratus lumborum block in conjunction with continuous lumbar plexus block for postoperative analgesia

3 days

In-hospital stay for surgery and initial recovery

Follow-up

Participants are monitored for pain control and adverse events post-surgery

2 weeks

Regular monitoring every 12 hours for pain scores and daily for opioid consumption

Treatment Details

Interventions

• Erector Spinae Block
• Quadratus Lumborum Block
• Ropivacaine

Trial Overview The study tests the effectiveness of two types of nerve blocks—quadratus lumborum block (QLB) and erector spinae block (ESB)—when used alongside a continuous lumbar plexus block for post-surgery pain relief in hip PAO surgery. It aims to determine if there's a difference in pain control between these two methods.

Participant Groups

Group I: Erector spinae supplemental block Experimental Treatment 2 Interventions

Single-shot T9/T10 operative side erector spinae block using ropivacaine 0.2%, 0.5ml/kg.

Group II: Quadratus lumborum supplemental block Active Control 2 Interventions

Single-shot T9/T10 operative side quadratus lumborum (type 1) block using ropivacaine 0.2%, 0.5ml/kg.

Who Is Running the Clinical Trial?

Boston Children's Hospital

Lead Sponsor

Trials

801

Recruited

5,584,000+

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]

References

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

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study. [2019]

2. India pubmed.ncbi.nlm.nih.gov

Comparison of Ultrasound-Guided Lumbar Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Hip and Proximal Femur Surgery: A Prospective Randomized Feasibility Study. [2022]

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

Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study. [2021]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Comparative efficacy of quadratus lumborum type-II and erector spinae plane block in patients undergoing caesarean section under spinal anaesthesia: a randomised controlled trial. [2023]

5. Italy pubmed.ncbi.nlm.nih.gov

Comparison of ultrasound-guided quadratus lumborum block and erector spinae plane block in terms of their effects on postoperative pain in open nephrectomy. [2023]

6. 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]