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.

中文翻译：

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腰方肌阻滞在全髋关节置换术中的镇痛作用：系统评价和荟萃分析

据报道，腰方肌阻滞 (QLB) 可减轻全髋关节置换术后的疼痛并改善功能；然而，评估在该人群中将该阻滞加入全身麻醉或脊髓麻醉的益处的随机对照试验是相互矛盾的。我们进行了一项系统评价，寻求随机对照试验调查全髋关节置换术中 QLB 的益处，对在全身麻醉或脊髓麻醉中添加 QLB 进行分层比较。主要结果是 24 小时曲线下面积 (AUC) 疼痛评分。疼痛评分是在 10 厘米视觉模拟量表上的人群特异性最小临床重要差异 1.86 厘米或 5.58 厘米·小时的 AUC 疼痛评分的背景下解释的。次要结果包括镇痛药的消耗、功能恢复和阿片类药物相关的副作用。在所有，纳入了 18 项试验（1318 名患者）。在全身麻醉或脊髓麻醉中加入 QLB 可改善 24 小时 AUC 静息痛评分，平均差 (95%CI) 分别为 -3.56 cm.h（-6.70 至 -0.42；p = 0.034）和 - 4.19 cm.h（-7.20分别为 -1.18；p = 0.014）。这些改进未能达到预先确定的最小临床重要差异，止痛剂消耗的减少也是如此。腰方肌阻滞改善了全身麻醉的功能恢复，但不改善脊髓麻醉。无论麻醉方式如何，QLB 都能减少阿片类药物相关的副作用。低到中等质量的证据表明，在全身麻醉或脊髓麻醉中添加 QLB 在多大程度上减少了全髋关节置换术后的术后疼痛和阿片类药物的消耗具有统计学意义，但对大多数患者而言可能在临床上并不重要。然而，在全身麻醉中加入 QLB 可能会促进功能恢复。总之，我们的研究结果不支持常规使用QLB作为全髋关节置换术多模式镇痛方案的一部分。