Vol. 7, Issue 2, Part B (2025)

Bipolar hemiarthroplasty (BHA) is a common surgical intervention for femoral neck fractures. Hip fractures can negatively affect a person’s mobility, mental health and overall independence. Effective postoperative pain management is critical to ensure early mobilization and optimal recovery. Traditional techniques such as epidural analgesia and femoral nerve block often lead to undesirable side effects including hypotension and quadriceps weakness. Therefore, newer nerve blocks like Ultrasound-guided regional blocks like the quadratus lumborum-3 (QLB-3) and lumbar erector spinae plane (ESP) blocks have gained popularity to provide post- operative analgesia and offer promising alternatives with fewer motor side effects and stable hemodynamic.
Aims and Objective: To compare the effectiveness of ultrasound-guided quadratus lumborum-3(QLB-3) and lumbar erector spinae plane (ESP)blocks for postoperative analgesia in patients undergoing bipolar hemiarthroplasty (BHA).
Methods: In this prospective, randomized, double-blinded study, 80 patients aged between 25 to 75 yrs undergoing unilateral BHA under spinal anaesthesia were randomly assigned into two equal groups (n=40) to receive either a QLB-3 block or an ESP block using a standard dose of 2.0 to 2.5 ml of bupivacaine hydrochloride in dextrose was administered intrathecally for adequate surgical anaesthesia. The primary outcome was to compare post-operative analgesia between QLB-3 and ESP plane block using numeric rating scale score (NRS), score was assessed over a 24-hour postoperative period. Secondary outcomes included post-operative opioid consumption after bipolar hemiarthroplasty (BHP) and incidence of block related complications.
Results: The results of this study demonstrated that both groups were demographically and clinically comparable. NRS scores at 2 hours postoperatively were similar in both groups (QLB-3: 1.1±0.42; ESP: 1.125±0.404; p = 0.792). However, the QLB-3 group demonstrated significantly lower NRS scores at 6, 12, 18, and 24 hours (p<0.001). Fewer patients in the QLB-3 group required rescue analgesia at all time intervals, with the highest difference observed at 19-24 hours (ESP: 16 vs. QLB-3: 9). Regarding safety, both blocks were well tolerated, with no reported cases of hemodynamic instability. However, two patients (5%) in the ESP group experienced nausea and vomiting, likely due to the reduced need for opioid-based rescue analgesia. 
Conclusion: The ultrasound-guided QL-3 block provides superior analgesia compared to the lumbar ESP block following bipolar hemiarthroplasty, as demonstrated by reduced opioid consumption, lower pain scores, and prolonged analgesic duration. These findings indicate that QLB-3 is more effective for prolonged pain relief and opioid sparing, making it a preferable regional anaesthesia technique for postoperative pain management in bipolar hemiarthroplasty patients.