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Peer-reviewedCC BY-NC-ND 4.0Balkan Medical Journal

Anterior Quadratus Lumborum Block for Postoperative Analgesia in Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis

  • Burhan Dost1
  • Yunus Emre Karapinar2
  • Esra Turunc1
  • Engin İhsan Turan3
  • Madan Narayanan4
  • Dario Bugada5
  • Alessandro De Cassai6,7
7 affiliations
  1. 1Department of Anesthesiology and Reanimation, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
  2. 2Department of Anesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
  3. 3Clinic of Anaesthesiology and Reanimation, University of Health Sciences Türkiye, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
  4. 4Frimley Park Hospital, NHS Frimley Health Foundation Trust, Camberley, UK
  5. 5Department of Emergency and Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
  6. 6Department of Medicine (DIMED), University of Padua, Padua, Italy
  7. 7Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
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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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Cite

BibTeXRIS
BibTeX
@article{dost2026anterior,
  title = {{Anterior Quadratus Lumborum Block for Postoperative Analgesia in Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis}},
  author = {Burhan Dost and Yunus Emre Karapinar and Esra Turunc and Engin İhsan Turan and Madan Narayanan and Dario Bugada and Alessandro De Cassai},
  journal = {Balkan Medical Journal},
  year = {2026},
  month = nov,
  doi = {10.4274/balkanmedj.galenos.2026.2026-8-37},
  url = {https://doi.org/10.4274/balkanmedj.galenos.2026.2026-8-37},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Anterior Quadratus Lumborum Block for Postoperative Analgesia in Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis
AU  - Burhan Dost
AU  - Yunus Emre Karapinar
AU  - Esra Turunc
AU  - Engin İhsan Turan
AU  - Madan Narayanan
AU  - Dario Bugada
AU  - Alessandro De Cassai
PY  - 2026
DA  - 2026/11/02
JO  - Balkan Medical Journal
DO  - 10.4274/balkanmedj.galenos.2026.2026-8-37
UR  - https://doi.org/10.4274/balkanmedj.galenos.2026.2026-8-37
AB  - 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.
SN  - 2146-3123
SN  - 2146-3131
ER  -