Anterior Quadratus Lumborum Block for Postoperative Analgesia in Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis.
Burhan Dost, Yunus Emre Karapinar, Esra Turunc et al.
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In 30 seconds
This systematic review and meta-analysis of 16 randomized controlled trials involving 994 patients assessed anterior quadratus lumborum block (aQLB) for postoperative analgesia after hip surgery. Compared with control approaches, aQLB was associated with lower opioid consumption over 24 hours: mean difference −6.60 mg morphine milligram equivalents (95% CI, −10.46 to −2.74; p = 0.003; I² = 94%). The review also found reductions in pain scores, postoperative nausea and vomiting, and rescue analgesic requirements. However, the authors judged the benefits small, not consistently clinically important, and supported by low-certainty evidence for key outcomes.
Key findings
- Across 16 RCTs and 994 patients, 24-hour opioid consumption was lower with aQLB (mean difference, −6.60 mg MME; 95% CI, −10.46 to −2.74; p = 0.003; I² = 94%).
- aQLB was associated with reduced pain scores, postoperative nausea and vomiting, and rescue analgesic requirements.
- There were no significant differences in time to rescue analgesia, mobilization, or hospital stay.
- Evidence certainty was low for 24-hour MME, pain at rest, and rescue analgesic requirements; it was moderate for movement pain at 6 hours and PONV.
Why it matters
Regional analgesia may reduce opioid exposure and some early postoperative symptoms after hip surgery. This synthesis suggests aQLB can provide measurable benefits, but the reported effects were small and did not consistently meet thresholds for clinical importance. The high heterogeneity in opioid-consumption results and low certainty for several outcomes warrant caution when interpreting the pooled estimates.
What to keep in mind
The evidence was low certainty for several key outcomes, and opioid-consumption results showed substantial heterogeneity (I² = 94%). The abstract also notes that benefits did not consistently exceed established thresholds for clinical importance.