METHODS A retrospective study with before and after design was performed in 210 elective total hip arthroplasty patients. Control group (N=132) received spinal anesthesia with periarticular injection (PAI), and Treatment group (N=78) received transmuscular quadratus lumborum block and lateral femoral cutaneous nerve block in addition to spinal anesthesia and PAI. Primary outcome was VAS pain score on postoperative day (POD) 1, secondary outcomes included VAS and opioid consumption on each POD, hospitalization cost, length of stay, and discharge acuity.
RESULTS The mean VAS and opioid consumption (MME) were significantly lower in the treatment group than that in the control group on POD 1, with VAS difference=-1.10, 95% CI, -1.64 to -0.55, False discover rate corrected P<0.001, and MME difference=-26.19, 95 CI%, -39.16 to -13.23, P<0.001. A significant difference was also found for both VAS (P=0.007) and opioid consumption (P=0.018) on POD 2 and for opioid consumption on POD 3 (P=0.008). Length of stay (days) in control group versus treatment group was 2.50±1.38 versus 1.36±0.95 (P=0.002), and the total cost of hospitalization was over 20% higher in the control group than that in treatment group (P=0.002).
DISCUSSION The addition of transmuscular quadratus lumborum and lateral femoral cutaneous nerve block in total hip arthroplasty provides improved analgesia indicated by lower pain scores and opioid reduction, and accelerated recovery with shorter hospitalization and decreased hospitalization cost.