Comparison Of Ultrasound-guided Quadratus Lumborum Block And Pericapsular Nerve Group Block For Analgesia After Total Hip Arthroplasty

Objectives: Patients often suffer from severe pain after total hip arthroplasty so that early ambulation is difficult.The quadratus lumborum block and pericapsular nerve group block may be used for analgesia after total hip arthroplasty.The primary aim of this study was to compare the analgesic efficacy of anterior quadratus lumborum block and pericapsular nerve group block after total hip arthroplasty,assess effect on quadriceps muscle strength and postoperative complications in order to provide better pain management solutions for patients,improving patients’ comfort during the perioperative period,and enhanced recovery after surgery.Methods: In a double-blinded randomized comparative trial,a total of 60 patients undergoing elective unilateral total hip arthroplasty received analgesia with either quadratus lumborum block or pericapsular nerve group block.Patients were randomized into two groups at a 1:1 ratio through a random number table:Group Q(30 participants): Quadratus lumborum block combined with general anesthesia,Group P(30 participants): Pericapsular nerve group block combined with general anesthesia.The local anesthetic in both groups was 0.5% ropivacaine 20 ml.All patients were performed nerve block by the experienced senior anesthesiologist and implemented standardized anesthesia.Duration of puncture,the rate of one time to puncture successfully,duration of surgery,intraoperative consumption of opioids,pain scores during the rest and the movement at 3,6,24,and 48 hours after surgery,quadriceps strength(Lovett muscle strength grading),incidence of quadriceps muscle weakness(muscle strength grading ≤2)at 3,6,24,and 48 hours after surgery and the rate of early ambulation on the day of surgery,the time for 8-foot(2.4m)walk in first day after surgery.Other data included age,sex,Body Mass Index,American Society of Anesthesiologists grading,length of stay after surgery,patient satisfaction,sleep quality on the night of surgery,the dosage of postoperative analgesic requirement,adverse events(nausea and vomiting,incision site infection)were recorded.Results: There were no significant differences in age,BMI,gender,American Society of Anesthesiologists grading,preoperative diagnosis and surgical orientation between the two groups(P > 0.05).Pain scores during the rest at 3 and 6 hours after surgery in Group P was significantly lower than that in Group Q(P<0.05).There were no significant differences in pain scores at various time points during the movement(P>0.05).Quadriceps strength at 3 and 6 hours after surgery in Group P was significantly higher than that in Group Q(P<0.05),patients had a lower incidence of quadriceps weakness and higher rate of early ambulation on the day of surgery in Group P(P<0.05).Group P had shorter time for 8-foot walk(2.4m)in first day after surgery(P<0.05).The rate of one time to puncture successfully was significantly higher and duration of puncture was shorter in Group P than that in Group Q(P<0.05).There were no significant differences in intraoperative consumption of opioids,length of stay patient satisfaction,adverse events(nausea and vomiting,incision site infection),the dosage of postoperative analgesic requirement(P>0.05).Conclusion: Compared with the quadratus muscle block,pericapsular nerve group block has better analgesic effect,less effect on the quadriceps strength and lower incidence of quadriceps weakness after total hip arthroplasty,it is more convenient to operate and patients are more cooperative with pericapsular nerve group block.It can be used as a priority choice of nerve block analgesia technique in enhanced recovery after total hip arthroplasty.