Quadratus lumborum block in hip arthroplasty: when multimodal analgesia is enough

We thank Arce Gálvez and colleagues for their interest in our randomized, placebo-controlled trial of anterior quadratus lumborum block (QLB) as an adjunct to multimodal analgesia for total hip arthroplasty.1 2 They make a fair point: the dose, concentration, volume, and compartmental spread of local anesthetic all bear on the efficacy of a fascial plane block, and our results cannot rule out every conceivable anterior QLB regimen. But our conclusion was more specific in stating that in adults undergoing primary total hip arthroplasty on a standardized Nonsteroidal Anti-Inflammatory Drugs (NSAID) based multimodal pathway, adding an anterior QLB with 20 mL of ropivacaine 0.2% did not lower opioid consumption or improve pain compared with placebo.1