Comparison of Analgesic Efficacy between Suprainguinal Fascia Iliaca Block (SFIB) and Quadratus Lumborum Block-3 (QLB-3) in Total Hip Arthroplasty

Objective: Total hip arthroplasty (THA) is an orthopedic surgical procedure commonly performed to alleviate pain and movement restrictions resulting from conditions such as osteoarthritis and can cause severe postoperative pain. To manage this pain, several peripheral nerve blocks, which are crucial components of multimodal analgesia, have been described. The suprainguinal fascia iliaca block (SFIB) and the anterior quadratus lumborum block (a-QLB) are two regional anesthesia techniques used for postoperative analgesia in THA. This study aimed to compare the analgesic efficacy of SFIB and a-QLB techniques in patients undergoing THA surgery performed with a posterior approach under spinal anesthesia. Methods: This prospective, randomized, and double-blind study was conducted at Samsun University, Samsun Education and Research Hospital. Patients aged 18-75 years, classified as American Society of Anesthesiologists (ASA) class I-II-III, scheduled for elective THA under spinal anesthesia were included. After randomization, patients were divided into two groups: SFIB and a-QLB. In both groups, the block procedure was performed under ultrasound guidance after the surgery. Our primary endpoint was the 24-hour cumulative morphine consumption, and the analgesic efficacy of the two groups was compared based on this parameter. Secondary outcomes included the time to first analgesia, postoperative pain score, presence of quadriceps muscle weakness, nausea-vomiting and QoR-15 survey results. Results: A total of 65 patients, 35 females and 30 males, were included in the study (Group SFIB: 33, Group a-QLB: 32). The 24-hour cumulative morphine consumption was found to be 9.94 ± 7.64 mg in the SFIB group and 11.31 ± 6.85 mg in the a-QLB group, with no statistically significant difference between the two groups at any time frame (p>0.05). Additionally, the NRS values were similar between the two groups (p>0.05). Although the time to first analgesia was longer in the SFIB group, no significant difference was observed between the two groups (p>0.05). The number of patients observed with quadriceps weakness in the 24th hour postoperatively was higher in the SFIB group compared to the a-QLB group (p<0.05). The incidence of nausea and vomiting was similar in both groups (p>0.05). The QoR-15 results at postoperative 24 hours were also similar between the two groups, with results generally reported as moderate to good by the patients. Conclusions: In this study, it was shown that there was no difference between SFIB and a-QLB performed postoperatively in patients undergoing THA surgery under spinal anesthesia in terms of analgesic requirements and pain scores. However, prolonged quadriceps muscle weakness, which can be considered as one of the block-related complications, was observed in more patients in the SFIB group compared to the a-QLB group. These findings suggest that both techniques are applicable for post-TKA pain management, yet randomized controlled trials comparing block applications with different volumes and concentrations are needed.