A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy

Ryan E Blackwell; Michael Kushelev; John Norton; Robert Pettit; W Kelton Vasileff

doi:10.1016/j.asmr.2020.08.002

A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy

Arthrosc Sports Med Rehabil. 2020 Dec 24;3(1):e7-e13. doi: 10.1016/j.asmr.2020.08.002. eCollection 2021 Feb.

Authors

Ryan E Blackwell¹, Michael Kushelev², John Norton², Robert Pettit¹, W Kelton Vasileff^{1

3}

Affiliations

¹ Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
² Department of Anesthesia, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
³ Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.

Abstract

Purpose: To evaluate the effect of the single-shot quadratus lumborum (QL) block versus femoral nerve and fascia iliacus (F/FI) blocks performed preoperatively on perioperative opioid requirements, subjective pain scores, and time to discharge.

Methods: Patients who underwent hip arthroscopy for femoroacetabular impingement and had a preoperative nerve block between January 2017 and August 2019 at our institution were identified. Patients were separated into 2 groups: those who either received a preoperative single-shot QL block or a preoperative single-shot F/FI block. All patients received general anesthesia. Intraoperative, postanesthesia care unit (PACU), and total morphine equivalents were analyzed using unpaired t test. Secondary outcome measures including total time in PACU and block-related complications were recorded and analyzed as well.

Results: One hundred one patients were retrospectively reviewed. Forty-three patients received preoperative QL blocks, and 58 patients received preoperative F/FI blocks. Demographics and operative characteristics were similar between the 2 groups. Patients receiving a QL block required significantly lower total morphine equivalents (63.1 vs 87.0, P < .001). Patients receiving a QL block also had shorter PACU stays (116 vs 148 minutes, P < .001) and lower subjective pain scores at the time of discharge (3.27 vs 4.98, P < .001) compared with the F/FI block group. There were also significant decreases in the number of intraoperative opioids (42.1 vs 58.4, P < .001) and PACU opioids (20.7 vs 28.7, P = .03) used when analyzed separately. Two patients in the femoral nerve block group had noted a fall postoperatively while the block was in effect. No patients in the QL block group had a block-related complication.

Conclusions: Patients receiving a preoperative QL block for hip arthroscopy demonstrated lower total opioid requirements, shorter PACU stay, and lower pain scores at discharge than patients receiving preoperative F/FI blocks with no reported adverse events.

Level of evidence: Level III, retrospective comparative trial.