Ultrasound-assisted quadratus lumborum block as a method of postoperative analgesia in total hip arthroplasty: a single-center prospective randomized study

Background: Using regional postoperative analgesia in total hip arthroplasty (THA) minimizes pain and opioid consumption while preserving patient mobility. Quadratus lumborum block (QLB) has demonstrated these effects in abdominal surgery; however, its application in trauma and orthopedics remains understudied. Aim: To evaluate the efficacy and safety of combining lateral and posterior approaches to QLB as a component of multimodal analgesia for postoperative pain management after THA. Materials and methods: This single-center prospective randomized study included 153 patients aged 48–65 years undergoing THA. Participants were divided into two groups: Group 1 received preoperative QLB, while Group 2 served as the control. All patients underwent spinal anesthesia with intravenous sedation and received analgesia as part of multimodal pain management. Postoperative outcomes on the first day were assessed by measuring pain intensity using the visual analog scale (VAS) at rest and during mobilization, walking distance, opioid consumption, and the incidence of side effects from opioid use. Results: VAS pain scores at 6, 12, and 24 hours postoperatively were significantly lower in the QLB group compared to the control group (p 0.001). Walking distance also differed: Group 1 patients walked 10 [5; 20] m within the first 12 hours and 40 [30; 50] m within 24 hours, compared to 5 [0; 10] m and 30 [20; 40] m, respectively, in the control group (p 0.017). In Group 1, 28 (50.67%) patients did not require opioids, and 37 (49.33%) needed them only once. In the control group, all patients required opioids, with 38 (50.67%) requesting repeated doses (p 0.001). Conclusion: This study demonstrated that QLB effectively reduces pain, opioid consumption, and associated complications while increasing mobility, confirming its efficacy and safety as a postoperative analgesic method for THA.