A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy

Purpose To evaluate the effect of the single‐shot quadratus lumborum (QL) block versus femoral nerve and fascia iliacus (F/FI) blocks performed preoperatively on perioperative opioid requirements, subjective pain scores, and time to discharge. Methods Patients who underwent hip arthroscopy for femoroacetabular impingement and had a preoperative nerve block between January 2017 and August 2019 at our institution were identified. Patients were separated into 2 groups: those who either received a preoperative single‐shot QL block or a preoperative single‐shot F/FI block. All patients received general anesthesia. Intraoperative, postanesthesia care unit (PACU), and total morphine equivalents were analyzed using unpaired t test. Secondary outcome measures including total time in PACU and block‐related complications were recorded and analyzed as well. Results One hundred one patients were retrospectively reviewed. Forty‐three patients received preoperative QL blocks, and 58 patients received preoperative F/FI blocks. Demographics and operative characteristics were similar between the 2 groups. Patients receiving a QL block required significantly lower total morphine equivalents (63.1 vs 87.0, P < .001). Patients receiving a QL block also had shorter PACU stays (116 vs 148 minutes, P < .001) and lower subjective pain scores at the time of discharge (3.27 vs 4.98, P < .001) compared with the F/FI block group. There were also significant decreases in the number of intraoperative opioids (42.1 vs 58.4, P < .001) and PACU opioids (20.7 vs 28.7, P = .03) used when analyzed separately. Two patients in the femoral nerve block group had noted a fall postoperatively while the block was in effect. No patients in the QL block group had a block‐related complication. Conclusions Patients receiving a preoperative QL block for hip arthroscopy demonstrated lower total opioid requirements, shorter PACU stay, and lower pain scores at discharge than patients receiving preoperative F/FI blocks with no reported adverse events. Level of Evidence Level III, retrospective comparative trial.