A Comparative Evaluation of Quadratus Lumborum Block Versus Fascia Iliaca Nerve Block for Patients Undergoing Elective Total Hip Replacement Under Spinal Anaesthesia

Total hip replacement is a commonly performed surgical procedure with up to 4,500 procedures performed annually in Ireland and up to 400,000 per year in the United States. Most of the patients experience moderate to severe pain in the initial post-operative period. Multimodal analgesia with peripheral nerve blockade is recommended as the gold standard modality for management of lower limb joint replacements. The limitations with peripheral nerve block include duration of therapy with single shot injections and associated motor block which can delay rehabilitation.

Transmuscular Quadratus Lumborum injection has been described recently as an effective option for post-operative analgesia in patients undergoing total hip replacement. Single injection can provide analgesia for up to 24 hours. We aim to investigate if a TQL block when compared to FIB provides superior analgesia and less motor block in the acute post-operative period.

All patients scheduled for elective hip replacement surgery will be contacted prior to the surgery (at least 24 hours) over the telephone and information about the nature and purpose of the study will be provided to them by Anaesthesia personnel who are involved in the study. They will be directed to a dedicated page on our website to further inform themselves, if desired. Written informed consent will be obtained from all patients prior to participation in the study. Patients can remove their consent without question at any time during or after the study.

Patients will be randomised to either the TQL group (intervention group) or FIB group (conventional group) by computer generated random numbers and allocation will be enclosed in sealed envelopes. Due to the nature of the intervention, the Anaesthetist performing/supervising the block and patient receiving the block cannot be blinded. Outcome measurements will be recorded by study observers blinded to the group allocation.

On arrival to the Anaesthesia induction room baseline monitoring (non-invasive blood pressure, pulse oximetry and 3-lead ECG) and intravenous access will be established. Patients in both groups will be positioned sitting on a level trolley with feet resting on a foot rest. They will be given a pillow to hug and requested to maintain an arched back posture with an assistant holding the patient to aid positioning. No sedation will be given prior to or during administration of spinal anesthesia.