Quadratus lumborum block vs femoral/fascia iliaca block for hip surgeries: A systematic review and meta-analysis.

Objective: The current systematic review was conducted to compare quadratus lumborum block (QLB) vs fascia iliaca block (FIB) and femoral nerve block (FNB) for improving analgesic outcomes in patients undergoing hip surgeries.

Methods: We searched for randomized controlled trials from inception to on Embase, PubMed, Web of Science, clinical trial registry, and Google Scholar comparing QLB vs FIB/FNB for hip surgeries. The search was initiated on 1^st December and culminated on 5^th December 2023 to include all studies published from inception till the last day of the search. The primary outcome was 24 hours total analgesic consumption in morphine equivalents. Secondary outcomes were pain scores and incidence of quadriceps weakness at 24 hours, and postoperative nausea and vomiting (PONV).

Results: Six RCTs were eligible. The meta-analysis found that 24-hours morphine consumption was found to be significantly lower in the FIB/FNB group as compared to the QLB group. Pain scores on the 10-point scale were not significantly different between the two groups at one to two hours, two to four hours, 12 hours, 24 hours, and 48 hours. Incidence of quadriceps weakness and PONV was also not significantly difference between the two groups.

Conclusion: Meta-analysis of a limited number of RCTs shows that QLB does not provide better postoperative analgesia as compared to FIB/FNB after hip surgery. Twenty four hours total opioid consumption was significantly higher with QLB but without any difference in pain scores. Incidence of quadriceps weakness and PONV does not differ between QLB and FIB/FNB.