Background: Postoperative pain following hip surgery remains challenging to manage despite the use of multimodal analgesia. Anterior quadratus lumborum block (aQLB) has been proposed as an effective regional analgesic technique; however, its clinical efficacy remains uncertain. Aims: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate whether aQLB reduces postoperative opioid consumption and pain following hip surgery. Study design: Systematic review and meta-analysis. Methods: PubMed, Scopus, Embase, CENTRAL, and Web of Science were systematically searched through March 2026. The primary outcome was 24-hour postoperative opioid consumption. Random-effects models were used for all pooled analyses. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Subgroup and sensitivity analyses and trial sequential analysis were also performed. Results: Sixteen RCTs involving 994 patients were included in the analysis. aQLB reduced 24-hour postoperative opioid consumption, expressed as morphine milligram equivalents (MME) (mean difference, -6.60 mg; 95% confidence interval, -10.46 to -2.74; p = 0.003; I² = 94%). aQLB also reduced pain scores, postoperative nausea and vomiting (PONV), and rescue analgesic requirements, with no significant differences in time to rescue analgesia, mobilization, or hospital stay. The certainty of evidence was low for 24-hour MME, pain at rest across all assessed time points, and rescue analgesic requirements, and moderate for pain during movement at 6 hours and PONV. Conclusion: aQLB was associated with statistically significant reductions in 24-hour postoperative opioid consumption, early postoperative pain at rest, rescue analgesic requirements, and PONV after hip surgery. However, the magnitude of these benefits was small and did not consistently exceed established thresholds for clinical importance, and the certainty of evidence remained low.
Anterior Quadratus Lumborum Block for Postoperative Analgesia in Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis
Cassai, Alessandro De
2026
Abstract
Background: Postoperative pain following hip surgery remains challenging to manage despite the use of multimodal analgesia. Anterior quadratus lumborum block (aQLB) has been proposed as an effective regional analgesic technique; however, its clinical efficacy remains uncertain. Aims: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate whether aQLB reduces postoperative opioid consumption and pain following hip surgery. Study design: Systematic review and meta-analysis. Methods: PubMed, Scopus, Embase, CENTRAL, and Web of Science were systematically searched through March 2026. The primary outcome was 24-hour postoperative opioid consumption. Random-effects models were used for all pooled analyses. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Subgroup and sensitivity analyses and trial sequential analysis were also performed. Results: Sixteen RCTs involving 994 patients were included in the analysis. aQLB reduced 24-hour postoperative opioid consumption, expressed as morphine milligram equivalents (MME) (mean difference, -6.60 mg; 95% confidence interval, -10.46 to -2.74; p = 0.003; I² = 94%). aQLB also reduced pain scores, postoperative nausea and vomiting (PONV), and rescue analgesic requirements, with no significant differences in time to rescue analgesia, mobilization, or hospital stay. The certainty of evidence was low for 24-hour MME, pain at rest across all assessed time points, and rescue analgesic requirements, and moderate for pain during movement at 6 hours and PONV. Conclusion: aQLB was associated with statistically significant reductions in 24-hour postoperative opioid consumption, early postoperative pain at rest, rescue analgesic requirements, and PONV after hip surgery. However, the magnitude of these benefits was small and did not consistently exceed established thresholds for clinical importance, and the certainty of evidence remained low.
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