Impact of preoperative continuous supra-inguinal fascia iliaca block or anterior quadratus lumborum block versus conventional analgesia on quality of recovery after hip fracture surgery: A three-arm randomized clinical trial

Background Effects of preoperative continuous regional block on perioperative analgesia and postoperative recovery in hip fracture patients remain to be determined. This randomized trial was designed to investigate the impact of continuous supra-inguinal fascia iliaca block (FIB) or anterior quadratus lumborum block (QLB) on quality of recovery after hip fracture surgery. Methods Eligible patients were randomized to receive continuous supra-inguinal FIB, continuous anterior QLB, or conventional analgesia (no block; control group). Continuous regional blocks were initiated at hospital admission and induced with 40 ml of 0.375% ropivacaine and maintained with 5 ml/h of 0.2% ropivacaine, and reinforced with 30 ml of 0.375% ropivacaine before surgery. The primary endpoint was quality of recovery (QoR) assessed with the QoR-40 questionnaire at 24 hours after surgery. Secondary endpoints included pain intensity before and after surgery. Results A total of 159 patients were randomized, with 53 patients in each group. The QoR-40 score at 24 hours was median 184 [IQR 176 to 187] in the control group, 185 [178 to 191] with supra-inguinal FIB, and 188 [182 to 191] with anterior QLB (P = 0.042), respectively; the QoR-40 score was higher in the anterior QLB group than in the control group (median difference 4; 95% CI 1 to 7; P = 0.008) although this difference was not clinically important. Both regional blocks alleviated pain intensity before surgery, but only anterior QLB provided better analgesia for up to 72 postoperative hours. Conclusions Preoperative continuous anterior QLB improved perioperative analgesia and slightly improved early postoperative recovery whereas continuous supra-inguinal FIB did not. Trial Registration www.chictr.org.cn,ChiCTR2000037857