Comparison of Quadratus Lumborum Plus Modified Erector Spinae Plane Block versus Pericapsular Nerve Group Block Plus Lateral Femoral Cutaneous Block on Postoperative Analgesia and Functional Recovery in Total Hip Arthroplasty: A Retrospective Propensity Score-Matched Study

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Purpose: Ultrasound-guided quadratus lumborum plus modified erector spinae plane (QLESP) block and pericapsular nerve group (PENG) plus lateral femoral cutaneous nerve (LFC) block are novel regional analgesia techniques for total hip arthroplasty (THA). This retrospective study aimed to compare the analgesic efficacy and opioid-related outcomes of the QLESP block and the PENG + LFC block following THA. Methods: This retrospective study included 2180 patients who underwent THA between January 2022 and December 2024. In this study, 272 patients received the QLESP block (QLESP group) and 420 patients accepted the PENG + LFC block (PELF group). Propensity score matching (PSM) was performed to match patients in a 1:1 ratio. Results: Of 2180 patients identified, 256 pairs between QLESP group and PELF group were successfully matched. In the match cohort, the QLESP group demonstrated significantly lower cumulative sufentanil consumption (QLESP: 13.0 ± 1.3 μg; PELF: 14.6 ± 3.3 μg; p < 0.001) and patient-controlled intravenous analgesia (PCIA) frequency (QLESP: 1 (0– 3); PELF: 2 (0– 4); P < 0.001) at 6 hours postoperatively compared to the PELF group. Additionally, the QLESP group was associated with a lower incidence of rescue analgesia (QLESP: 9.0%; PELF: 15.2%; P = 0.030) and a shorter postoperative length of stay (QLESP: 10.6 ± 6.0 days; PELF: 11.7 ± 6.2 days; P = 0.038). No significant differences were found in visual analogue scale (VAS) or time to first walk. Conclusion: This observational study suggested that the QLESP block was associated with a modest reduction in early postoperative sufentanil consumption, PCIA frequency at 6 hours, and postoperative length of stay for total hip arthroplasty, compared to PENG + LFC block. Given the inherent limitations of the retrospective PSM design, the routine incorporation of these blocks into enhanced recovery pathways for total hip arthroplasty in clinical practice warrants further large randomized controlled trials. Keywords: erector spinae plane block, lateral femoral cutaneous nerve, pericapsular nerve group block, postoperative analgesia, quadratus lumborum block, total hip arthroplasty

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