Trial Outcomes & Findings for Lumbar Plexus vs Quadratus Lumborum Block in Post-operative Pain Following Total Hip Replacement (NCT NCT03801265)

NCT ID: NCT03801265

Last Updated: 2021-07-15

Results Overview

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest. A higher score means worse outcomes.

• Recruitment status: COMPLETED
• Study phase: PHASE4
• Target enrollment: 46 participants
• Primary outcome timeframe: 6 hours after surgery
• Results posted on: 2021-07-15

Participant Flow

Participant milestones

Measure	Lumbar Plexus Block 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Overall Study STARTED	23	23
Overall Study COMPLETED	23	23
Overall Study NOT COMPLETED	0	0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Lumbar Plexus vs Quadratus Lumborum Block in Post-operative Pain Following Total Hip Replacement

Baseline characteristics by cohort

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Total n=46 Participants Total of all reporting groups
Age, Continuous	65.7 years STANDARD_DEVIATION 9.8 • n=5 Participants	68.6 years STANDARD_DEVIATION 11.8 • n=7 Participants	67.1 years STANDARD_DEVIATION 10.7 • n=5 Participants
Sex: Female, Male Female	11 Participants n=5 Participants	13 Participants n=7 Participants	24 Participants n=5 Participants
Sex: Female, Male Male	12 Participants n=5 Participants	10 Participants n=7 Participants	22 Participants n=5 Participants
Race/Ethnicity, Customized Caucasian	16 Participants n=5 Participants	19 Participants n=7 Participants	35 Participants n=5 Participants
Race/Ethnicity, Customized African American	7 Participants n=5 Participants	4 Participants n=7 Participants	11 Participants n=5 Participants
Region of Enrollment United States	23 Participants n=5 Participants	23 Participants n=7 Participants	46 Participants n=5 Participants

PRIMARY outcome

Timeframe: 6 hours after surgery

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest. A higher score means worse outcomes.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Pain at Rest After Surgery	3.4 score on a scale Standard Deviation 3.0	3.6 score on a scale Standard Deviation 1.9

PRIMARY outcome

Timeframe: 6 hours after surgery

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain with movement. A higher score means worse outcomes.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Pain With Movement After Surgery	4.9 score on a scale Standard Deviation 3.2	4.7 score on a scale Standard Deviation 2.0

PRIMARY outcome

Timeframe: 12 hours after surgery

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest. A higher score means worse outcomes.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Pain at Rest After Surgery	3.0 score on a scale Standard Deviation 2.9	2.8 score on a scale Standard Deviation 2.0

PRIMARY outcome

Timeframe: 12 hours after surgery

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain with movement. A higher score means worse outcomes.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Pain With Movement After Surgery	4.5 score on a scale Standard Deviation 2.8	4.6 score on a scale Standard Deviation 2.1

PRIMARY outcome

Timeframe: 24 hours after surgery

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest. A higher score means worse outcomes.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Pain at Rest After Surgery	2.8 score on a scale Standard Deviation 2.6	1.8 score on a scale Standard Deviation 1.5

PRIMARY outcome

Timeframe: 24 hours after surgery

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain with movement. A higher score means worse outcomes.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Pain With Movement After Surgery	4.9 score on a scale Standard Deviation 2.8	4.3 score on a scale Standard Deviation 1.8

SECONDARY outcome

Timeframe: 24 hours after surgery

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain with movement. A higher score means worse outcomes.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Pain During Physical Therapy	4.3 score on a scale Standard Deviation 2.5	4.2 score on a scale Standard Deviation 1.3

SECONDARY outcome

Timeframe: 24 hours after surgery

Narcotics will be converted to oral morphine equivalents

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Total Opioid Consumption During 24 Hours After Surgery	14.0 mg oral morphine equivalents Standard Deviation 9.3	14.7 mg oral morphine equivalents Standard Deviation 10.7

SECONDARY outcome

Timeframe: within 24 hours after surgery

This measurement is from T0 being out of surgery room time to the point at which the participant was able to walk 100 feet during the first day post-surgery. Values were abstracted from the patient medical records.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Postoperative Time to Accomplish Walking 100 Feet	1449.1 minutes Standard Deviation 760.7	1358.3 minutes Standard Deviation 715.5

SECONDARY outcome

Timeframe: during surgery

Duration that the patient underwent the block procedure during surgery in minutes

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Block Procedure Duration	11.7 minutes Standard Deviation 6.1	6.6 minutes Standard Deviation 4.7

SECONDARY outcome

Timeframe: 12 hours after surgery

patients who report having post-surgical quadriceps weakness.

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Patients With Postoperative Quadriceps Weakness	15 Participants	6 Participants

SECONDARY outcome

Timeframe: 24 hours after surgery

Patient electronic medical records were reviewed for total acetaminophen consumption during 24 hours after surgery in milligrams (mg)

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Total Acetaminophen Consumption During 24 Hours After Surgery	2782.6 milligrams (mg) Standard Deviation 902.3	3087.0 milligrams (mg) Standard Deviation 949.3

SECONDARY outcome

Timeframe: 24 hours after surgery

Patient electronic medical records were reviewed for total celecoxib consumption during 24 hours after surgery in milligrams (mg)

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Total Celecoxib Consumption During 24 Hours After Surgery	191.3 milligrams (mg) Standard Deviation 185.7	178.3 milligrams (mg) Standard Deviation 180.8

SECONDARY outcome

Timeframe: 24 hours after surgery

Patient electronic medical records were reviewed for total ketorolac consumption during 24 hours after surgery in milligrams (mg)

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Total Ketorolac Consumption During 24 Hours After Surgery	9.8 milligrams (mg) Standard Deviation 17.3	12.4 milligrams (mg) Standard Deviation 24.2

SECONDARY outcome

Timeframe: 24 hours after surgery

Patient electronic medical records were reviewed for total gabapentin consumption during 24 hours after surgery in milligrams (mg)

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Total Gabapentin Consumption During 24 Hours After Surgery	382.6 milligrams (mg) Standard Deviation 238.7	395.7 milligrams (mg) Standard Deviation 481.9

SECONDARY outcome

Timeframe: 24 hours after surgery

Patient electronic medical records were reviewed for total oral ketamine consumption during 24 hours after surgery in milligrams (mg)

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Total Oral Ketamine Consumption During 24 Hours After Surgery	7.4 milligrams (mg) Standard Deviation 12.5	13.5 milligrams (mg) Standard Deviation 22.9

SECONDARY outcome

Timeframe: 6 hours after surgery

Narcotics will be converted to oral morphine equivalents

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Opioid Consumption During 0-6 Hours After Surgery	3.4 mg oral morphine equivalents Standard Deviation 3.2	6.3 mg oral morphine equivalents Standard Deviation 4.5

SECONDARY outcome

Timeframe: 6-12 hours after surgery

Narcotics will be converted to oral morphine equivalents

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Opioid Consumption During 6-12 Hours After Surgery	5.0 mg oral morphine equivalents Standard Deviation 4.2	3.4 mg oral morphine equivalents Standard Deviation 4.0

SECONDARY outcome

Timeframe: 12-24 hours after surgery

Narcotics will be converted to oral morphine equivalents

Outcome measures

Measure	Lumbar Plexus Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Lumbar plexus block: Patient will be positioned in lateral decubitus position with side to be blocked facing upwards. Midline will be identified by palpating the spinous process. Intercristal line will be drawn connecting iliac crests. The point of needle insertion will be 4 cm lateral to the intersection of both lines. The transverse process will first contact with a finder needle. Subsequently an 18 gauge 10 cm insulated needle will be used and advanced until it contacted the transverse process. Needle will then be redirected cephalad or caudad and advanced 2 cm, until the quadriceps femoris twitch is obtained. Local anesthetic will then be injected after confirming a motor response between 0.3-0.5 milli amperes. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.	Quadratus Lumborum Type 3 Block n=23 Participants 0.5% ropivacaine 100 mg (20 ml) will be injected Quadratus lumborum type 3 block: Patient will be placed in a lateral position with the side to be blocked facing up. A low frequency transducer will be used to identify three layers of abdominal musculature, probe will be then moved posteriorly till the transverse abdominus aponeurosis is visualized, the QL muscle is then identified by tracing the aponeurosis posteriorly. The transducer is then moved more posteriorly to visualize the shadow of transverse process and the origin of QL muscle. Psoas muscle is then identified lying anterior to the QL muscle. A 22 gauge 8 cm is inserted in plane posterior to the probe and advanced intramuscularly through the QL to interfacial plane between QL and psoas major and local anesthetic is deposited. Ropivacaine injection: 0.5% ropivacaine 20 ml (100 mg) will be injected for both groups.
Opioid Consumption During 12-24 Hours After Surgery	5.7 mg oral morphine equivalents Standard Deviation 4.6	5.0 mg oral morphine equivalents Standard Deviation 5.9

Adverse Events

Lumbar Plexus Block

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Quadratus Lumborum Type 3 Block

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Sharad Khetarpal, MD

University of Pittsburgh

Phone: 4126235020

Email: khetarpalsk@upmc.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place