Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA.
Department of Anesthesiology and Pain Medicine, Women's College Hospital, University of Toronto, ON, Canada.
Anaesthesia. 2022 Oct;77(10):1152-1162. doi: 10.1111/anae.15823. Epub 2022 Aug 10.
The quadratus lumborum block (QLB) is reported to reduce pain and improve function following total hip arthroplasty; however, randomised controlled trials evaluating the benefits of adding this block to general or spinal anaesthesia in this population are conflicting. We performed a systematic review seeking randomised controlled trials investigating QLB benefits for total hip arthroplasty, stratifying comparisons regarding the addition of QLB to either general or spinal anaesthesia. The primary outcome was 24-h area under the curve (AUC) pain score. Pain scores were interpreted in the context of a population-specific minimal clinically important difference of 1.86 cm on a 10-cm visual analogue scale, or an AUC pain score of 5.58 cm.h. Secondary outcomes included analgesic consumption, functional recovery and opioid-related side-effects. In all, 18 trials (1318 patients) were included. Adding QLB to general or spinal anaesthesia improved 24-h AUC rest pain scores by a mean difference (95%CI) of -3.56 cm.h (-6.70 to -0.42; p = 0.034) and - 4.19 cm.h (-7.20 to -1.18; p = 0.014), respectively. These improvements failed to reach the pre-determined minimal clinically important difference, as did the reduction in analgesic consumption. Quadratus lumborum block improved functional recovery for general, but not spinal, anaesthesia. Opioid-related side-effects were reduced with QLB regardless of anaesthetic modality. Low-to-moderate quality evidence suggests that the extent to which adding QLB to either general or spinal anaesthesia reduces postoperative pain and opioid consumption after total hip arthroplasty is statistically significant but may be clinically unimportant for most patients. However, adding QLB to general anaesthesia might enhance functional recovery. Taken together, our findings do not support the routine use of QLB as part of multimodal analgesic regimens for total hip arthroplasty.
腰方肌阻滞（QLB）被报道可减轻全髋关节置换术后的疼痛并改善功能；然而，评估在该人群中加入该阻滞以辅助全身或脊髓麻醉的益处的随机对照试验结果存在争议。我们进行了一项系统评价，旨在寻找调查 QLB 对全髋关节置换术益处的随机对照试验，对将 QLB 加入全身或脊髓麻醉的效果进行分层比较。主要结局是 24 小时 AUC 疼痛评分。疼痛评分在特定人群中以 10cm 视觉模拟量表上 1.86cm 的最小临床重要差异或 AUC 疼痛评分 5.58cm.h 为背景进行解释。次要结局包括镇痛消耗、功能恢复和阿片类药物相关副作用。共纳入 18 项试验（1318 名患者）。将 QLB 加入全身或脊髓麻醉分别使 24 小时 AUC 静息疼痛评分平均改善了 -3.56cm.h（-6.70 至 -0.42；p=0.034）和-4.19cm.h（-7.20 至 -1.18；p=0.014）。这些改善均未达到预先确定的最小临床重要差异，镇痛消耗的减少也未达到。QLB 改善了全身麻醉下的功能恢复，但对脊髓麻醉无影响。无论麻醉方式如何，QLB 均可减少阿片类药物相关副作用。低至中等质量的证据表明，无论在全身或脊髓麻醉中加入 QLB 均可在统计学上显著减轻全髋关节置换术后的疼痛和阿片类药物消耗，但对大多数患者可能没有临床意义。然而，在全身麻醉中加入 QLB 可能会增强功能恢复。综上所述，我们的研究结果不支持将 QLB 常规用作全髋关节置换术多模式镇痛方案的一部分。
