Impact of preoperative continuous supra-inguinal fascia iliaca block or anterior quadratus lumborum block versus conventional analgesia on quality of recovery after hip fracture surgery: A three-arm randomized clinical trial

Impact of preoperative continuous supra-inguinal fascia iliaca block or anterior quadratus lumborum block versus conventional analgesia on quality of recovery after hip fracture surgery: A three-arm randomized clinical trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of preoperative continuous supra-inguinal fascia iliaca block or anterior quadratus lumborum block versus conventional analgesia on quality of recovery after hip fracture surgery: A three-arm randomized clinical trial Xue Li, Zhen-Zhen Xu, Yu-Ting Li, Hai-Feng Wang, Dong-Mei Ni, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8504943/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Feb, 2026 Read the published version in BMC Anesthesiology → Version 1 posted 11 You are reading this latest preprint version Abstract Background Effects of preoperative continuous regional block on perioperative analgesia and postoperative recovery in hip fracture patients remain to be determined. This randomized trial was designed to investigate the impact of continuous supra-inguinal fascia iliaca block (FIB) or anterior quadratus lumborum block (QLB) on quality of recovery after hip fracture surgery. Methods Eligible patients were randomized to receive continuous supra-inguinal FIB, continuous anterior QLB, or conventional analgesia (no block; control group). Continuous regional blocks were initiated at hospital admission and induced with 40 ml of 0.375% ropivacaine and maintained with 5 ml/h of 0.2% ropivacaine, and reinforced with 30 ml of 0.375% ropivacaine before surgery. The primary endpoint was quality of recovery (QoR) assessed with the QoR-40 questionnaire at 24 hours after surgery. Secondary endpoints included pain intensity before and after surgery. Results A total of 159 patients were randomized, with 53 patients in each group. The QoR-40 score at 24 hours was median 184 [IQR 176 to 187] in the control group, 185 [178 to 191] with supra-inguinal FIB, and 188 [182 to 191] with anterior QLB (P = 0.042), respectively; the QoR-40 score was higher in the anterior QLB group than in the control group (median difference 4; 95% CI 1 to 7; P = 0.008) although this difference was not clinically important. Both regional blocks alleviated pain intensity before surgery, but only anterior QLB provided better analgesia for up to 72 postoperative hours. Conclusions Preoperative continuous anterior QLB improved perioperative analgesia and slightly improved early postoperative recovery whereas continuous supra-inguinal FIB did not. Trial Registration www.chictr.org.cn,ChiCTR2000037857 Supra-inguinal fascia iliaca block Anterior quadratus lumborum block Hip fracture Quality of recovery Analgesia Figures Figure 1 Figure 2 Figure 3 Introduction Hip fracture is the leading cause of severe illness and disability in individuals aged over 65 years [ 1 ], for which timely surgery remains the mainstay treatment [ 2 ]. Patients with hip fracture always experience severe pain [ 3 ], which not only decreases patients’ satisfaction and comfort but also increases the risks of delirium and other complication [ 4 , 5 ]. Recent guideline advocates early pre-operative optimization for hip fracture management, of which regional block is a good choice for acute pain control [ 6 , 7 ]. When compared with systemic opioids, regional block holds more advantages such as superior analgesic effect, avoidance of opioid-related side effects, and improved functional recovery [ 8 ]. Supra-inguinal fascia iliaca block (FIB) and anterior quadratus lumborum block (QLB) are two commonly used methods for hip fracture analgesia. Supra-inguinal FIB aims blocking the three branches of lumbar plexus (lateral femoral cutaneous nerve, femoral nerve, and obturator nerve) and has a better spread of local anesthetic under fascia iliaca when compared with the infra-inguinal approach [ 9 ]. A recent cohort study showed that supra-inguinal fascia iliaca catheterization provided a longer duration of analgesia than single-shot block and was safe in hip fracture patients [ 10 ]. As for anterior QLB, local anesthetic is injected between quadratus lumborum and psoas major muscles and produces the lower thoracic paravertebral block or approximated lumbar plexus block depending on location of the needle tip [ 11 ]. Previous studies found that single-shot anterior QLB significantly reduced pain intensity for up to 24 hours after hip surgery and decreased opioids consumption within 48 hours compared to no block[ 12 ], and its analgesic efficacy is non-inferior to lumbar plexus block [ 13 ]. However, benefit of these blocks on patients’ recovery after hip fracture surgery are not clear. Continuous nerve block via catheterization provides persistent analgesia, which is more suitable for hip fracture patients since it provides extended analgesia till surgery is completed. We supposed that, by improving analgesia, preoperative continuous supra-inguinal FIB or continuous anterior QLB started from admission could improve quality of recovery in older patients after hip fracture surgery. The primary endpoint of this trial was the quality of recovery assessed with the QoR-40 questionnaire at postsurgical 24 hours. Methods Design and Participants The present study was an observer-blinded, randomized trial with three parallel arms, which was conducted in accordance with the CONSORT guidelines. Potential participants were screened after hospital admission. We included patients aged 65 years or older who were admitted with hip fracture, scheduled for proximal femoral nail anti-rotation or joint replacement surgery, and gave consent to participate in the trial. We excluded patients who had (1) a body mass index (BMI) > 30 kg.m − ² or body weight IV, (3) a diagnosis of multiple fractures, (4) contraindications to nerve block or allergic history to ropivacaine, (5) preoperative therapy with opioids or non-steroid anti-inflammatory drugs for more than 3 months, or (6) unable to communicate due to delirium, dementia, central and / or peripheral nervous system diseases, language disorders or other end-stage diseases. Randomization and blinding Random numbers were generated using the "blockrand" package of R statistical software (version 4.3.1, Vienna, Austria) in a 1:1:1 ratio with a block size of 6. Randomization was stratified according to the type of scheduled surgical procedure, i.e., the proximal femoral nail anti-rotation or the joint replacement surgery. The generated random numbers were sealed in sequentially numbered opaque envelops until preoperative intervention. Since we had two intervention groups which required different positions when performing nerve blocks and a control group without nerve block, patients and catheterization operators were not blinded. However, investigators who were responsible for outcome evaluations were blinded to study group assignments. Interventions Supra-inguinal FIB or anterior QLB and catheterization were usually performed by two fixed investigators who were expertized in regional block on the day or the second day of admission. Patients taking anticoagulant or antiplatelet drugs were invited to participate in the trial only if they had sufficient time after suspending these medications. Continuous supra-inguinal FIB group Patients were placed in the supine position. A high-frequency linear ultrasound transducer (Logiq E, GE, Chicago, IL, USA) was positioned obliquely between the anterior superior iliac spine and the umbilicus to identify the iliac muscle and fascia iliaca. A continuous nerve block needle (Stimuplex D, B. Braun, Melsungen, Germany) was advanced in-plane from lateral to medial direction. After penetrating the iliac fascia, a test dose of 3 mL normal saline was injected. The location of the needle tip was good if the injectate diffused between the hyperechoic iliac fascia and hypoechoic iliac muscle; a dose of 0.375% ropivacaine 40 mL (Naropine, AstraZeneca AB, Stockholm, Sweden) was then injected, followed by placement of a catheter (Supplementary Fig. 1A and 1B). The catheter was connected to a pump which was established with 250 ml of 0.2% ropivacaine and programmed to deliver a continuous infusion of 5 ml/h till the patient arrived at the operation room. Analgesia was reinforced with 30 ml of 0.375% ropivacaine through the catheter, which was then removed in plan due to aseptic consideration from the surgeon. Continuous anterior QLB group Patients were placed in the lateral position, with surgical limb in the upper side. A low-frequency ultrasound transducer was placed at the midpoint between the costal margin and the iliac crest (L4 vertebra level) to identify the classic "shamrock" sign. The needle was advanced in-plane from posterior to anterior direction. When the needle penetrated the anterior thoracolumbar fascia between quadratus lumborum and psoas major muscles, a test dose of 3 mL normal saline was injected. The location of the needle tip was good if the injectates diffused beneath the anterior thoracolumbar fascia and pressed down the psoas major or made psoas major ventrally forward, a dose of 0.375% ropivacaine 40 mL was first injected, followed by placement of a catheter (Supplementary Fig. 1C and 1D). The catheter was connected to a pump which was programmed the same as that in the continuous supra-inguinal FIB group. Control group Patients were provided with standard preoperative analgesia, i.e., oxycodone-acetaminophen tablets (each tablet contains oxycodone hydrochloride 5 mg and acetaminophen 325 mg) were administrated every 8 hours. No regional block or catheterization was performed through the perioperative period. Perioperative management At the time of enrolment, baseline pain intensity both at rest and with movement (defined as position changing for sacral care) was assessed with the numeric rating scale (NRS, an 11-point scale where 0 = no pain and 10 = the worst pain; a difference of ≥1 point was considered clinically meaningful [ 14 ] ). For patients given regional block, dermatomal sensory block in the anterior and lateral thigh were performed by cold sensation testing with an ice cube and pain intensity was re-assessed 1 hour later. Successful block was defined as the simultaneous presence of reduced cold sensation compared to the corresponding area of contralateral leg and a reduction from baseline of more than 1 point of NRS pain score at rest. All enrolled patients were followed up for pain intensity once daily till the day of surgery. Rescue systemic opioids were allowed if the NRS pain score at rest remained ≥4. General anesthesia or neuraxial anesthesia was performed at the discretion of anesthesiologists. For patients in the supra-inguinal FIB and anterior QLB groups, 30 ml of 0.375% ropivacaine was injected via the indwelling catheter; the catheter was then removed before surgical disinfection. After surgery, a patient-controlled intravenous analgesic pump (1.25 µg/ml sufentanil) was provided for all enrolled patients and set to deliver 4-mL boluses at a 10-minute lockout interval without background infusion. Non-steroid anti-inflammatory drugs (100 mg flurbiprofen axetil or 40 mg parecoxib sodium, intravenous injection every 12 hours) were prescribed for up to 3 days after surgery, unless there were contraindications. Tramadol, morphine, or oxycodone-acetaminophen tablets could be used as rescue drugs in the ward. Analgesic target was to maintain NRS pain score of < 4. Data collection and outcome assessment Baseline data including demographics, educational years, surgical diagnosis, comorbidities and Charlson Comorbidity Index, important laboratory and echocardiographic results, and American Society of Anesthesiologists classification were collected. Baseline evaluations included frail status, sleep quality, daily activity and mobility before fracture (assessed with the modified Frailty Index, Pittsburgh Sleep Quality Index, Barthel Index and Parker Mobility Scale, respectively). Besides, the risk of death in patients above 70 years were evaluated with the Almelo Hip Fracture Score. For patients undergoing spinal anesthesia, pain intensity when changing body position was assessed with the NRS; the satisfaction score of anesthesiologists with patient positioning was evaluated with a 5-point Likert scale. Intraoperative data including type of anesthesia, medications, durations of anesthesia and surgery, type of surgical approach, and intraoperative fluid balance were collected. After surgery, patients were followed up at 6, 24, 48, and 72 hours for pain intensity (both at rest and with movement), opioid consumption, and subjective sleep quality. Quality of recovery at 24 hours after surgery was evaluated with the validated Quality of Recovery-40 (QoR-40) questionnaire with a total score from 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery)[ 15 ]. A minimal difference of 6.3 points was considered clinically important [ 16 ]. Before hospital discharge, daily activity was reassessed with the Barthel Index; hip joint function was evaluated with the modified Harris Hip Score (score ranges from 0 to 91, with higher score indicating better hip function). We also documented complications during hospitalization and length of hospital stay. At 90 days after surgery, we contacted patients via telephone. Besides hip joint function assessment, pain and disability was evaluated with the Oxford Hip Score (OHS; score ranges from 0 to 60, with higher score indicating worse health state). Chronic pain was defined as NRS pain score ≥ 3 in the surgical area. The vital status and any hospital readmission were recorded. Nerve block-related adverse events, intraoperative arrhythmia, hypotension, hypertension, bradycardia, tachycardia as well as postoperative nausea and vomiting within 72 hours were monitored. Outcomes Our primary endpoint was the quality of recovery (assessed with the QoR-40) at 24 hours after surgery. Secondary endpoints included pain intensity at preset timepoints, length of hospital stay, complications during hospital stay, daily activity and hip joint function at hospital discharge, and hip joint function as well as pain and disability at 90 days after surgery. The QoR-40 score at hospital discharge was originally designated as a secondary endpoint but cancelled during the study period to simplify the evaluation. Sample size calculation In our preliminary data, the QoR-40 score (mean ± SD) at 24 hours after hip fracture surgery in patients given preoperative anterior QLB and conventional analgesia (each 10 patients) was 180 ± 16 and 171 ± 14, respectively. We assumed that supra-inguinal FIB would improve the QoR-40 score in a similar magnitude as with anterior QLB. With the significance level set at 0.05 and power at 0.9, the sample size required to detect differences was 47 cases per group. Considering a 10% dropout rate, a total of 159 cases (53 cases per group) was needed. The sample size calculation was performed using PASS software (version 15.0, NCSS PASS, Utah, USA). Statistical Analysis Outcome analysis was performed in the intention-to-treat population. For the primary endpoint, analysis was also performed in the per-protocol population, in which case patients with failed block or catheter dislodgement were excluded. For the primary endpoint, QoR-40 score at 24 postoperative hours, difference among three groups was assessed with the Kruskal-Wallis test and covariate-adjusted sensitivity analysis was also performed. For secondary endpoints and other analyses, continuous or ranked variables were analyzed using analysis of variance (ANOVA) or Kruskal-Wallis tests; categorical variables were compared using chi-square or Fisher's exact tests; time-to-event variables were assessed with Kaplan-Meier survival analyses and log-rank tests. As exploratory analysis, we also calculated area under curve (AUC) of pain intensity within 72 hours; results among three groups were analyzed with Kruskal-Wallis tests. Missing data was not imputed. A two-sided P -value of less than 0.05 was considered statistically significant. Pairwise comparisons were performed for variables with differences among three groups. The differences between two medians and 95% CIs were calculated with the Hodges-Lehmann estimators. A P-value of less than 0.0167 was considered statistically significant after Bonferroni correction. All statistical analyses were performed with statistical packages R (version 4.3.1, Vienna, Austria). Results From September 4, 2020 to July 7, 2023, 314 patients who were admitted for hip fracture surgery were screened. Of these, 189 patients were eligible, and 159 patients were finally enrolled and randomized into the control, continuous supra-inguinal FIB, and continuous anterior QLB groups, with 53 patients in each group. All enrolled patients were included in the intention-to-treat analysis. During the study period, there were 1 block failure (in the anterior QLB group) and 9 unexpected catheter dislocations before surgery (7 in the supra-inguinal FIB group and 2 in the anterior QLB group). These patients were excluded from the per-protocol analysis (Fig. 1 ). Baseline variables were well balanced among the three groups, except that pain intensity with movement was higher in the supra-inguinal FIB and anterior QLB groups than in the control group (Table 1 ). All intraoperative variables were comparable among the three groups, except that patients in the supra-inguinal FIB group had slightly lower lactate level. For patients who were given general anesthesia, those in the anterior QLB group required less sufentanil and dexmedetomidine than in the control group (Supplementary Table S1 ). Table 1 Baseline data Control ( n = 53) Supra-inguinal FIB ( n = 53) Anterior QLB ( n = 53) Age (year) 80 (70, 85) 82 (71, 87) 80 (72, 86) Body mass index (kg/m 2 ) 23.4 ± 3.5 24.2 ± 5.1 23.0 ± 4.1 Sex (M/F) 12 (22.6)/ 41(77.4) 16 (30.2)/ 37 (69.8) 12 (22.6)/ 41(77.4) Education (year) 12 (6, 15) 12 (6, 15) 9 (6, 12) Hip fracture type Femur neck 35 (66.0) 34 (64.2) 35 (66.0) Intertrochanteric 16 (30.2) 19 (35.8) 16 (30.2) Subtrochanteric 2 (3.8) 0 (0.0) 2 (3.8) Comorbidities Stroke 13 (24.5) 14 (26.4) 14 (26.4) Other CNS diseases a 3 (5.7) 7 (13.2) 3 (5.7) Asthma/chronic bronchitis/COPD 4 (7.5) 4 (7.5) 6 (11.3) Hypertension 34 (64.2) 36 (67.9) 34 (64.2) Coronary artery disease 13 (24.5) 9 (17) 9 (17) Arrythmia 5 (9.4) 8 (15.1) 9 (17) Other heart diseases b 1 (1.9) 2 (3.8) 1 (1.9) Diabetes Mellitus 19 (35.8) 22 (41.5) 15 (28.3) Other metabolic diseases c 3 (5.7) 4 (7.5) 2 (3.8) Chronic kidney disease 3 (5.7) 8 (15.1) 3 (5.7) History of tumors 5 (9.4) 8 (15.1) 8 (15.1) Charlson comorbidity index 0 (0, 1) 0 (0, 1) 0 (0, 1) ASA physical classification II 23 (43.4) 15 (28.3) 16 (30.2) III 30 (56.6) 38 (71.7) 37 (69.8) Modified Frailty Index (point) d 1 (1, 2) 2 (1, 2) 1 (1, 2) Pittsburgh Sleep Quality Index (point) e 6 (4, 10) 6 (4, 11) 8 (5, 11) Barthel Index (point) f 100 (95, 100) 100 (90, 100) 100 (95, 100) Parker Mobility Score (point) g 9 (7, 9) 9 (5, 9) 9 (6, 9) Almelo Hip Fracture Score (point) h 7 (4, 8) [ 10 ] 8 (6, 9) [ 9 ] 7 (5, 9) [ 10 ] Time interval from fracture to enrolment (hour) 51 (26, 144) 40 (23, 81) 48 (29, 74) Pain intensity at enrolment NRS pain score, at rest i 2 (1, 3) 2 (1, 4) 2 (1, 3) NRS pain score, with movement i 6 (6, 8) 9 (7, 9) 7 (6, 9) Total time for continuous block (day) NA 2 (1–2) 2 (1–2) Values are presented as median (Q1, Q3), number (%) or mean ± SD. Numbers in square brackets indicate patients with missing data. FIB, fascia iliaca block; QLB, quadratus lumborum block; CNS, central nervous system; COPD, chronic obstruction pulmonary disease; ASA, American Society of Anesthesiologists; NRS: numeric rating scale; NA: not applicable. a Included transient ischemic attack, Parkinson's disease, history of neurosurgery. b Included valve heart disease and permanent pacemaker implantation. c Included hyperlipidemia, hyperuricemia, and thyroid disease. d Score ranges from 0 to 11, with higher score indicating higher level of frailty. e Score ranges from 0 to 21, with higher score indicating worse sleep quality. f Used to assess an individual's independence in activities of daily living (ADLs) by assigning scores to tasks like feeding, bathing, and mobility; score ranges from 0 to 100, with higher scores signify greater self-sufficiency, and lower scores indicate higher dependency. g A composite measurement of the patient's mobility indoors, outdoors, and during shopping; the total score ranges from 0 to 9, with higher score indicates better ability to move. h Used to predict mortality of older (> 70 years) patients after surgery for hip fracture; score ranges from 3 to 19, with higher score indicating higher risk of mortality. i An 11-point scale where 0 = no pain and 10 = the worst pain. The QoR-40 score at 24 hours after surgery was median 184 [IQR 176 to 187] in the control group, 185 [178 to 191] in the supra-inguinal FIB group, and 188 [182 to 191] in the anterior QLB group (P = 0.042). Pairwise comparison showed that the QoR-40 score was higher in the anterior QLB group than in the control group (median difference 4; 95% CI 1 to 7; P = 0.008), but the difference was not clinically important (Fig. 2 ). Per-protocol analysis also showed similar results. Complications during hospital stay, length of hospital stay, Barthel index as well as hip function results at hospital discharge and 90 days after surgery did not differ among the three groups (Tables 2 ; Supplementary Table S2). Table 2 Efficacy outcomes Control ( n = 53) Supra-inguinal FIB ( n = 53) Anterior QLB ( n = 53) P value Primary endpoint Quality of recovery at 24 hours (point) a 184 (176, 187) 185 (178, 191) [ 1 ] 188 (182, 191) 0.042 Quality of recovery at 24 hours (point, PP analysis) a 184 (176, 187) ( n = 53) 185 (178, 191) ( n = 46) 188 (182, 191) ( n = 50) 0.055 Secondary endpoints Complications during hospital stay 15 (28.3) 15 (28.3) 13 (24.5) 0.880 Total length of hospital stay (day) 10 (7, 11) 11 (8, 14) 10 (8, 13) 0.292 Length of hospital stay after surgery (day) 7 (5, 8) 7 (6, 11) 7 (6, 9) 0.122 On the day of hospital discharge Barthel Index (point) b 65 (60, 80) [ 2 ] 65 (50, 75) [ 1 ] 70 (55, 80) 0.454 Modified Harris Hip Score (point) c 54 (44, 58) [ 2 ] 53 (45, 58) [ 1 ] 57 (46, 59) 0.427 At 90 days after surgery Barthel Index (point) b 90 (85, 95) [ 2 ] 90 (75, 95) [ 3 ] 95 (83, 100) [ 2 ] 0.227 Modified Harris Hip Score (point) c 71 (59, 76) [ 2 ] 70 (60, 79) [ 3 ] 72 (61, 80) [ 2 ] 0.498 Oxford Hip Score (point) d 26 (22, 31) [ 2 ] 25 (20, 34) [ 3 ] 25 (19, 32) [ 2 ] 0.764 Other endpoints and exploratory analysis In patients received axial anesthesia (n = 33) (n = 30) (n = 32) Satisfactory score with lateral position e 4 (3, 4) 5 (4, 5) 5 (5, 5) 0.001 Satisfactory ratio with lateral position e 20 (60.6) 30 (100.0) 31 (96.9) < 0.001 ICU admission after surgery 20 (37.7) 21 (39.6) 12 (22.6) 0.127 During 72 postoperative hours AUC of pain score at rest (point⋅h) f 66 (0, 114) 0 (0, 76) 0 (0, 30) 0.003 AUC of pain score with movement (point⋅h) f 246 (192, 312) 192 (140, 263) 168 (114, 216) < 0.001 Cumulative sufentanil equivalent (µg) g 40.0 (20.0, 63.2) 35.0 (15.0, 65.0) 24.8 (10.0, 45.0) 0.132 Subjective sleep quality (score) h First postoperative night 3 (2, 7) 3 (1, 7) [ 1 ] 3 (2, 6) 0.894 Second postoperative night 5 (3, 6) 3 (2, 5) 4 (2, 5) 0.282 Third postoperative night 4 (2, 5) 3 (2, 5) 3 (2, 5) 0.545 Mortality within 90 days 1 (1.9) [ 1 ] 0 (0 ) [ 3 ] 1 (1.9) [ 1 ] > 0.999 Readmission within 90 days 7 (13.5) [ 1 ] 5 (10.0) [ 3 ] 7 (13.5) [ 1 ] 0.829 Chronic pain at 90 days after surgery i 5 (9.8) [ 2 ] 4 (8.0) [ 3 ] 2 (3.9) [ 2 ] 0.544 Values are presented as median (Q1, Q3), number (%) or mean ± SD. Numbers in square brackets indicate patients with missing data. IQR, interquartile range; FIB, fascia iliaca block; QLB, quadratus lumborum block; PP, per-protocol; AUC, area under curve; PCA, patient-controlled analgesia. a Assessed with QoR-40 scale, which contains 40 items and its scores ranges from 0 to 200, with higher scores indicating better postoperative recovery. b Used to assess an individual's independence in activities of daily living (ADLs) by assigning scores to tasks like feeding, bathing, and mobility; score ranges from 0 to 100, with higher scores signify greater self-sufficiency, and lower scores indicate higher dependency. c Used to assess an individual's hip function through pain (44 points), as well as mobility and walking function (47 points), the latter aspects included limp gait (11 points), walking support (11 points), walking distance (11 points), ability for stairs (4 points), socks or shoes (4 points), sitting (5 points) and public transportation (1 point). In total, modified Harris hip score ranges from 0 to 91, with higher scores indicating better hip function. d The Oxford hip score (OHS) is a reliable, joint-specific, self-administered questionnaire for assessing hip pain and disability with 12-item and a total value of 60 scores, where the higher the score, the worse the health state. e Satisfaction scale of anesthesiologists who performed the spinal anesthesia, assessed with a five-point Likert scale where 1 = very dissatisfied, 2 = dissatisfied, 3 = moderate, 4 = satisfied, 5 = very satisfied. A scale of 4 or higher indicates satisfied with the lateral position. f Pain intensity was assessed with the numeric rating scale where 0 indicates the no pain and 10 indicates the worst pain. AUC calculated during 72 postoperative hours. g Indicated the total sufentanil equivalent consumed during 72 postoperative hours (including PCA pump). 1 Tylox tablet (containing 5 mg oxycodone) = 10 mg morphine (PO) = 3.3 mg morphine (IV) = 3.3 µg sufentanil (IV). 100 mg tramadol (PO) = 33.3 mg tramadol (IV) = 3.3 mg morphine (IV) = 3.3 µg sufentanil (IV). h Assessed with the numeric rating scale where 0 indicates the best sleep quality and 10 indicates the worst sleep quality. i Defined as NRS pain score ≥ 3 in the surgical area at 90 days postoperatively. Before surgery, pain intensity both at rest and with movement was lower in the two regional block groups at 1 hour and 1 day post-enrolment than in the control group (Fig. 3 A and 3 B, Supplementary Table S3). After surgery, pain intensity at rest was lower in the supra-inguinal FIB group at 72 hours (median differences 0 point; P = 0.016) and in the anterior QLB group at 24, 48, and 72 hours than in the control group (median differences 0 point; P≤0.006; Fig. 3 A; Supplementary Table S3), but the differences were not clinically important; pain intensity with movement was lower in the anterior QLB group at 6, 24, 48, and 72 hours than in the control group (median differences − 1 point; P≤0.011; Fig. 3 B; Supplementary Table S3). Exploratory analysis showed that, for patients who received neuraxial anesthesia, anesthesiologists were more satisfied with lateral positioning in the two nerve-block groups than in the control group, no matter if analyzed with the median difference of satisfactory score or the relative risk of satisfactory ratio. Among all patients, AUC of pain score both at rest and with movement within 72 hours after surgery were lower in the anterior QLB group than in the control group (at rest: median difference − 21 point⋅h; 95% CI -66 to 0; P < 0.001; with movement: median difference − 78 point⋅h; 95% CI -117 to -40; P < 0.001); there were no significant differences between the supra-inguinal FIB and control groups and between the anterior QLB and supra-inguinal FIB groups (Tables 2 and 3 ). Regarding to the difference in the pain score with movement at baseline among three groups and its potential influence to QoR-40 score, sensitivity analysis was performed with a linear regression model for the rank-transformed QoR-40 score, in which the pain score with movement at baseline was set as the covariate. Results indicated that the between-group differences remained consistent both before and after covariate adjustment (Table 3 ). Table 3 Pairwise Comparation of QoR-40 and Pain Score After Surgery Supra-inguinal FIB vs. control Anterior QLB vs. control Anterior QLB vs. supra-inguinal FIB MD or RR (95% CI) P value MD or RR (95% CI) P value MD or RR (95% CI) P value Primary endpoint Quality of recovery at 24 h (point) a 2 (-1, 5) 0.251 4 (1, 7) 0.008 2 (-1, 5) 0.312 Quality of recovery at 24 h (point, PP analysis) a 3 (-1, 6) 0.157 4 (1, 7) 0.014 1 (-2, 4) 0.543 Other endpoints and exploratory analysis At lateral position for neuraxial anesthesia Satisfactory score (point) b 1 (1, 1) < 0.001 1 (1, 1) < 0.001 0 (0, 0) 0.115 Satisfactory ratio b 1.65 (1.25, 2.17) < 0.001 1.60 (1.21, 2.12) < 0.001 0.97 (0.91, 1.03) 0.999 AUC of pain score during postoperative 72 h At rest (point⋅h) c -9 (-51, 0) 0.046 -21 (-66, 0) < 0.001 0 (-9, 0) 0.170 With movement (point⋅h) c -45 (-81, 6) 0.025 -78 (-117, -40) < 0.001 -34 (-69, 3) 0.063 Rank-transformed quality of recovery at 24 h (unadjusted) 12 (-6, 30) 0.193 22 (6, 39) 0.009 11 (-7, 29) 0.247 Rank-transformed quality of recovery at 24 h (adjusted for baseline NRS pain score with movement) 9 (-11, 28) 0.389 20 (2, 39) 0.027 12 (-6, 30) 0.195 P values in bold indicate < 0.0167 is considered statistically significant after Bonferroni correction. FIB, fascia iliaca block; QLB, quadratus lumborum block; MD, median difference; CI, confidence interval; RR, relative risk; AUC, area under curve. a Assessed with QoR-40 scale, which contains 40 items and its scores range from 0 to 200, with higher scores indicating better postoperative recovery. b Satisfaction scale of anesthesiologists who performed the spinal anesthesia, assessed with a five-point Likert scale where 1 = very dissatisfied, 2 = dissatisfied, 3 = moderate, 4 = satisfied, 5 = very satisfied. A scale of 4 or higher indicates satisfied with the lateral position. c Pain intensity was assessed with the numeric rating scale where 0 indicates the no pain and 10 indicates the worst pain. AUC calculated during 72 postoperative hours. Adverse events did not differ among three groups. No severe adverse events occurred during the study period (Supplementary Table S4). Discussion This randomized trial showed that, in patients admitted for hip fracture surgery, preoperative continuous anterior QLB from hospital admission produced a significant yet no clinically important improvement in quality of recovery at 24 postoperative hours, whereas continuous supra-inguinal FIB did not. Both approaches of continuous nerve block improved preoperative analgesia and satisfactory score/ratio of anesthesiologists with lateral position for spinal anesthesia; continuous anterior QLB provided better postoperative analgesia both at rest and with movement within 72 postoperative hours. Till now, the optimal regional block for perioperative analgesia in hip fracture patients remains to be determined[ 17 ]. Regional anesthesia for hip surgery should block the subcostal nerve together with the lumbar and sciatic plexus [ 18 ], whereas analgesia mainly focuses on the blockade of lumbar plexus or its terminal branches as they innervate the anterior hip joint capsule where nociceptive fibers are predominantly present[ 19 , 20 ]. Based on these considerations, supra-inguinal FIB and anterior QLB are used for analgesia after hip surgery. Indeed, previous studies showed that both supra-inguinal FIB [ 21 , 22 ] and anterior QLB [ 23 ] provided effective analgesia, as manifested by lowered pain score and reduced opioid consumption when compared with no block in hip surgery patients. On the other hand, negative results also exist, i.e., neither block improved analgesia when compared with no block [ 24 , 25 ]. In the present study, a bolus dose of local anesthetics was injected via the indwelling catheter before surgery in regional block groups, resembling the single-shot technique in previous studies. We found that patients given anterior QLB had better postoperative analgesia, thus resulted in slightly improved quality of recovery at 24 hours after surgery when compared with no block. Our result was consistent with a recent meta-analysis, which showed that the effect of anterior QLB lasted for up to 24 hours after surgery [ 23 ]. This was because anterior QLB was performed at L4 vertebra level in our patients, with local anesthetics diffused between the anterior thoracolumbar fascia and the psoas major muscle[ 26 ]. This technique stably blocks the femoral and lateral femoral cutaneous nerves and potentially blocks the lumbar plexus [ 27 , 28 ]. In our results, however, supra-inguinal FIB did not significantly improve analgesia after surgery and, thus, did not change quality of recovery at 24 hours after surgery. Our results were contradictory to previous findings that supra-inguinal FIB provided superior [ 29 ] or comparable analgesic effect when compared with QLB [ 30 ], but was in line with a recent trial which showed that ultrasound-guided supra-inguinal FIB did not significantly reduce opioid consumption compared with sham block [ 24 ]. Potential reasons leading to these inconsistences are not clear but may be related to the differences of nerve block techniques and surgical types. We did not find differences in terms of other secondary endpoints among the three groups. This was understandable since we only had 53 patients in each group. A recent meta-analysis also reported similar results, i.e. preoperative peripheral nerve block relieved pain intensity in hip fracture patients but did not change length of hospital stay [ 17 ]. More studies are needed to clarify the effects of preoperative nerve block on perioperative outcomes in this patient population. This study has several limitations. First, we didn't assess the QoR-40 score preoperatively, preventing adjustment the results for preoperative status. The observed median difference of QoR-40 score at postoperative 24 hour between QLB and conrol group is below the well recognized MCID ( about 6.3 point), so the clinical meaning of this result is limited despite statistical significant. Second, we did not standardize anesthetic methods for hip fracture surgery due to diverse conditions of patients. However, it was proved that the anesthetic method per se did not affect patients' clinical outcomes [ 31 ]. Third, the catheters were not retained for postsurgical analgesia due to strict disinfection of the operation area. Fourth, based on the present QoR-40 score of the three groups, we did a post-hoc power analysis with one-way analysis and found statistical power of this paper is insufficient. To achieve a statistical power of 0.8, a sample size of 432 cases will be required in the future study. Conclusion Among patients who were admitted for hip fracture surgery, preoperative continuous anterior QLB started from hospital admission improved pre- and postoperative analgesia and slightly improved early postoperative recovery when compared with no block, whereas continuous supra-inguinal FIB only improved preoperative analgesia. Declarations Ethics approval and consent to participate The trial protocol was approved by the Biomedical Research Ethics Committee of Peking University First Hospital (Approval Number: 2020 − 222) and registered with Chinese Clinical Trial Registry on September 2, 2020 ( www.chictr.org.cn , ChiCTR2000037857) before the first enrolment started (September 4, 2020). This study adhered to the principles of the Declaration of Helsinki.Written informed consent was obtained from each participant. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This trial was supported by the Foundation for the National Key Research and Development Program of China (Research on Comprehensive Technical Scheme for Perioperative Management of Elderly Patients). Author Contribution Concept and design: X L, H Z, D-J Z; Acquisition, analysis, or interpretation of data: Z-Z X, Y-T L, H-F W, D-M N; Supervision of the trial: D-M N, H Z, D-J Z; Drafting of the manuscript: X L, Z-Z X; Critical review of the manuscript: D-X W; All authors read and approved the final manuscript. Acknowledgement We sincerely appreciate the surgeon team (Yong-Ping Cao; Xin Yang; Yi-Lin Ye; Zhen-Ning Liu, Zhi-Chao Meng; Heng Liu; Hao Wu) in orthopedic department of Peking University First Hospital for their good cooperation with us during this trial. Data Availability The dataset supporting the conclusions of this article is uploaded in the Supplementary material (filename: dataset.xlsx). References Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003;51(3):364–70. Bhandari M, Swiontkowski M. Management of Acute Hip Fracture. N Engl J Med. 2017;377(21):2053–62. Ruhe MM, Veldhuis LI, Azijli-Abdelloui K, Schepers T, Ridderikhof ML. Prehospital analgesia in suspected hip fracture patients: adherence to national prehospital pain management guidelines. Eur J Trauma Emerg Surg. 2024;50(3):937–43. Thompson C, Brienza VJM, Sandre A, Caine S, Borgundvaag B, McLeod S. Risk factors associated with acute in-hospital delirium for patients diagnosed with a hip fracture in the emergency department. Cjem. 2018;20(6):911–9. Exsteen OW, Svendsen CN, Rothe C, Lange KHW, Lundstrøm LH. Ultrasound-guided peripheral nerve blocks for preoperative pain management in hip fractures: a systematic review. BMC Anesthesiol 2022, 22(1). Ong T, Vindlacheruvu M. A commentary update on NICE CG124. Hip fracture:management (2023). Age Ageing 2023, 52(6). Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral Nerve Blocks for Hip Fractures: A Cochrane Review. Anesth Analg. 2018;126(5):1695–704. Morrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, Jeng CL, Nelson BP, Rosenblatt MA, Silverstein JH, et al. Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial. J Am Geriatr Soc. 2016;64(12):2433–9. Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, Caerts B, Seynaeve P, Hadzic A, Van de Velde M. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Reg Anesth Pain Med 2019. James M, Bentley RA, Womack J, Goodman BA. Safety profile and outcome after ultrasound-guided suprainguinal fascia iliaca catheters for hip fracture: a single-centre propensity-matched historical cohort study. Can J Anaesth. 2022;69(9):1139–50. Wu J, Qin Y, She H, Ma R. Review of the injectate dispersion pattern during anterior quadratus lumborum block. Med (Baltim). 2022;101(48):e32038. Kukreja P, MacBeth L, Sturdivant A, Morgan CJ, Ghanem E, Kalagara H, Chan VWS. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Reg Anesth Pain Med 2019. Polania Gutierrez JJ, Ben-David B, Rest C, Grajales MT, Khetarpal SK. Quadratus lumborum block type 3 versus lumbar plexus block in hip replacement surgery: a randomized, prospective, non-inferiority study. Reg Anesth Pain Med. 2021;46(2):111–7. Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017;118(3):424–9. Gornall BF, Myles PS, Smith CL, Burke JA, Leslie K, Pereira MJ, Bost JE, Kluivers KB, Nilsson UG, Tanaka Y, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth. 2013;111(2):161–9. Myles PS, Myles DB, Galagher W, Chew C, MacDonald N, Dennis A. Minimal Clinically Important Difference for Three Quality of Recovery Scales. Anesthesiology. 2016;125(1):39–45. Hayashi M, Yamamoto N, Kuroda N, Kano K, Miura T, Kamimura Y, Shiroshita A. Peripheral Nerve Blocks in the Preoperative Management of Hip Fractures: A Systematic Review and Network Meta-Analysis. Ann Emerg Med. 2024;83(6):522–38. Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin. 2018;36(3):403–15. Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018;43(2):186–92. Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A, Vangsness CT Jr.. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012;22(1):75–81. Desmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, Lambrecht S, Croes K, Pottel H, Van de Velde M. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty. Reg Anesth Pain Med. 2017;42(3):327–33. Gola W, Bialka S, Owczarek AJ, Misiolek H. Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study. Int J Environ Res Public Health 2021, 18(9). Koo CH, Ahn S, Na HS, Ryu JH, Shin HJ. Efficacy of quadratus lumborum block for analgesia in adult participants undergoing hip surgery: A meta-analysis of randomized controlled trials. J Clin Anesth. 2021;75:110560. Safa B, Trinh H, Lansdown A, McHardy PG, Gollish J, Kiss A, Kaustov L, Choi S. Ultrasound-guided suprainguinal fascia iliaca compartment block and early postoperative analgesia after total hip arthroplasty: a randomised controlled trial. Br J Anaesth. 2024;133(1):146–51. Behera BK, Misra S, Sarkar S, Mishra N. A Systematic Review and Meta-Analysis of Efficacy of Ultrasound-Guided Single-Shot Quadratus Lumborum Block for Postoperative Analgesia in Adults Following Total Hip Arthroplasty. Pain Med. 2022;23(6):1047–58. Shao P, Li H, Shi R, Li J, Wang Y. Understanding fascial anatomy and interfascial communication: implications in regional anesthesia. J Anesth. 2022;36(4):554–63. Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016;117(3):387–94. Adhikary SD, El-Boghdadly K, Nasralah Z, Sarwani N, Nixon AM, Chin KJ. A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers. Anaesthesia. 2017;72(1):73–9. Refaat S, M MA, Elsherief IME, Mohamed MM. Ultrasound-guided fascia iliaca block versus quadratus lumborum block for perioperative analgesia in patients undergoing hip surgery. A randomised controlled trial. Anaesthesiol Intensive Ther. 2023;55(3):212–7. Mirkheshti A, Hashemian M, Abtahi D, Shayegh S, Manafi-Rasi A, Sayadi S, Memary E, Karami N, Rostamian B, Shakeri A. Quadratus Lumborum Block versus Fascia Iliaca Compartment Block for Acetabular Fracture Surgery by Stoppa Method: A Double-Blind, Randomized, Noninferiority Trial. Pain Res Manag. 2024;2024:3720344. Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, Sieber F, Magaziner J, Marcantonio ER, Mehta S, et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021;385(22):2025–35. Additional Declarations No competing interests reported. Supplementary Files SupplementTablesIndividualcomplications.docx FigureS1AD.jpg Supplementary Figure 1. Ultrasonic images (A) before and (B) after supra-inguinal fascia iliaca block; (C) before and (D) after anterior quadratus lumborum block. Blue dotted lines indicate the diffusion area of local anesthetics. LA, local anesthetics; QL, quadratus lumborum; PM, psoas major; L4, the 4 th lumbar vertebrae. Cite Share Download PDF Status: Published Journal Publication published 23 Feb, 2026 Read the published version in BMC Anesthesiology → Version 1 posted Editorial decision: Revision requested 27 Jan, 2026 Reviews received at journal 19 Jan, 2026 Reviews received at journal 17 Jan, 2026 Reviewers agreed at journal 17 Jan, 2026 Reviewers agreed at journal 16 Jan, 2026 Reviewers agreed at journal 16 Jan, 2026 Reviewers invited by journal 15 Jan, 2026 Editor assigned by journal 15 Jan, 2026 Editor invited by journal 07 Jan, 2026 Submission checks completed at journal 07 Jan, 2026 First submitted to journal 07 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8504943","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":576186926,"identity":"adabc5a8-39a2-416e-b619-285798a2e9e0","order_by":0,"name":"Xue Li","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Li","suffix":""},{"id":576186929,"identity":"e933519f-27b1-4515-9aa1-eac5ef40ad3c","order_by":1,"name":"Zhen-Zhen Xu","email":"","orcid":"","institution":"Peking University First 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2","display":"","copyAsset":false,"role":"figure","size":51965,"visible":true,"origin":"","legend":"\u003cp\u003eQuality of recovery at 24 hours after surgery among groups. Significant difference existed between continuous anterior quadratus lumborum block and control groups.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8504943/v1/8d36e3129fef6c4268a4b374.jpg"},{"id":100695643,"identity":"fe4b45b7-0ccc-45dc-bbd8-d4e3c01b4ff3","added_by":"auto","created_at":"2026-01-20 14:57:05","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":160433,"visible":true,"origin":"","legend":"\u003cp\u003eNRS of pain at rest (A) and with movement (B) among three groups at preset timepoints. \u003csup\u003e*\u003c/sup\u003e Significant difference existed between continuous supra-inguinal fascia iliaca block and control groups; \u003csup\u003e#\u003c/sup\u003e Significant difference existed between continuous anterior quadratus lumborum block and control groups.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8504943/v1/43077d2edb1e3844e064f14f.jpg"},{"id":103765586,"identity":"c8da7f92-17b9-4f01-8ffd-1df66cee537b","added_by":"auto","created_at":"2026-03-02 16:05:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1995698,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8504943/v1/a869c684-19bc-4808-a918-31f384a290d5.pdf"},{"id":100695497,"identity":"c4b5202a-dd5e-45df-b4e6-f35f86f83524","added_by":"auto","created_at":"2026-01-20 14:56:19","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34201,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementTablesIndividualcomplications.docx","url":"https://assets-eu.researchsquare.com/files/rs-8504943/v1/5ddc311dc0c691f9e92469e7.docx"},{"id":100695313,"identity":"5321cf83-d6b4-4b95-86ca-d821ca491948","added_by":"auto","created_at":"2026-01-20 14:53:14","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":497647,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Figure 1\u003c/strong\u003e. Ultrasonic images (A) before and (B) after supra-inguinal fascia iliaca block; (C) before and (D) after anterior quadratus lumborum block. Blue dotted lines indicate the diffusion area of local anesthetics. LA, local anesthetics; QL, quadratus lumborum; PM, psoas major; L4, the 4\u003csup\u003eth\u003c/sup\u003e lumbar vertebrae.\u003c/p\u003e","description":"","filename":"FigureS1AD.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8504943/v1/23696327ec8cc1cf467bc7e3.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of preoperative continuous supra-inguinal fascia iliaca block or anterior quadratus lumborum block versus conventional analgesia on quality of recovery after hip fracture surgery: A three-arm randomized clinical trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHip fracture is the leading cause of severe illness and disability in individuals aged over 65 years [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], for which timely surgery remains the mainstay treatment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Patients with hip fracture always experience severe pain [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which not only decreases patients\u0026rsquo; satisfaction and comfort but also increases the risks of delirium and other complication [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent guideline advocates early pre-operative optimization for hip fracture management, of which regional block is a good choice for acute pain control [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. When compared with systemic opioids, regional block holds more advantages such as superior analgesic effect, avoidance of opioid-related side effects, and improved functional recovery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSupra-inguinal fascia iliaca block (FIB) and anterior quadratus lumborum block (QLB) are two commonly used methods for hip fracture analgesia. Supra-inguinal FIB aims blocking the three branches of lumbar plexus (lateral femoral cutaneous nerve, femoral nerve, and obturator nerve) and has a better spread of local anesthetic under fascia iliaca when compared with the infra-inguinal approach [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A recent cohort study showed that supra-inguinal fascia iliaca catheterization provided a longer duration of analgesia than single-shot block and was safe in hip fracture patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. As for anterior QLB, local anesthetic is injected between quadratus lumborum and psoas major muscles and produces the lower thoracic paravertebral block or approximated lumbar plexus block depending on location of the needle tip [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Previous studies found that single-shot anterior QLB significantly reduced pain intensity for up to 24 hours after hip surgery and decreased opioids consumption within 48 hours compared to no block[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and its analgesic efficacy is non-inferior to lumbar plexus block [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, benefit of these blocks on patients\u0026rsquo; recovery after hip fracture surgery are not clear.\u003c/p\u003e \u003cp\u003eContinuous nerve block via catheterization provides persistent analgesia, which is more suitable for hip fracture patients since it provides extended analgesia till surgery is completed.\u003c/p\u003e \u003cp\u003eWe supposed that, by improving analgesia, preoperative continuous supra-inguinal FIB or continuous anterior QLB started from admission could improve quality of recovery in older patients after hip fracture surgery. The primary endpoint of this trial was the quality of recovery assessed with the QoR-40 questionnaire at postsurgical 24 hours.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and Participants\u003c/h2\u003e \u003cp\u003e The present study was an observer-blinded, randomized trial with three parallel arms, which was conducted in accordance with the CONSORT guidelines. Potential participants were screened after hospital admission. We included patients aged 65 years or older who were admitted with hip fracture, scheduled for proximal femoral nail anti-rotation or joint replacement surgery, and gave consent to participate in the trial. We excluded patients who had (1) a body mass index (BMI)\u0026thinsp;\u0026gt;\u0026thinsp;30 kg.m\u003csup\u003e\u0026minus;\u003c/sup\u003e\u0026sup2; or body weight\u0026thinsp;\u0026lt;\u0026thinsp;40 kg, (2) American Society of Association (ASA) classification\u0026thinsp;\u0026gt;\u0026thinsp;IV, (3) a diagnosis of multiple fractures, (4) contraindications to nerve block or allergic history to ropivacaine, (5) preoperative therapy with opioids or non-steroid anti-inflammatory drugs for more than 3 months, or (6) unable to communicate due to delirium, dementia, central and / or peripheral nervous system diseases, language disorders or other end-stage diseases.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRandomization and blinding\u003c/h3\u003e\n\u003cp\u003eRandom numbers were generated using the \"blockrand\" package of R statistical software (version 4.3.1, Vienna, Austria) in a 1:1:1 ratio with a block size of 6. Randomization was stratified according to the type of scheduled surgical procedure, i.e., the proximal femoral nail anti-rotation or the joint replacement surgery. The generated random numbers were sealed in sequentially numbered opaque envelops until preoperative intervention. Since we had two intervention groups which required different positions when performing nerve blocks and a control group without nerve block, patients and catheterization operators were not blinded. However, investigators who were responsible for outcome evaluations were blinded to study group assignments.\u003c/p\u003e\n\u003ch3\u003eInterventions\u003c/h3\u003e\n\u003cp\u003eSupra-inguinal FIB or anterior QLB and catheterization were usually performed by two fixed investigators who were expertized in regional block on the day or the second day of admission. Patients taking anticoagulant or antiplatelet drugs were invited to participate in the trial only if they had sufficient time after suspending these medications.\u003c/p\u003e\n\u003ch3\u003eContinuous supra-inguinal FIB group\u003c/h3\u003e\n\u003cp\u003ePatients were placed in the supine position. A high-frequency linear ultrasound transducer (Logiq E, GE, Chicago, IL, USA) was positioned obliquely between the anterior superior iliac spine and the umbilicus to identify the iliac muscle and fascia iliaca. A continuous nerve block needle (Stimuplex D, B. Braun, Melsungen, Germany) was advanced in-plane from lateral to medial direction. After penetrating the iliac fascia, a test dose of 3 mL normal saline was injected. The location of the needle tip was good if the injectate diffused between the hyperechoic iliac fascia and hypoechoic iliac muscle; a dose of 0.375% ropivacaine 40 mL (Naropine, AstraZeneca AB, Stockholm, Sweden) was then injected, followed by placement of a catheter (Supplementary Fig.\u0026nbsp;1A and 1B). The catheter was connected to a pump which was established with 250 ml of 0.2% ropivacaine and programmed to deliver a continuous infusion of 5 ml/h till the patient arrived at the operation room. Analgesia was reinforced with 30 ml of 0.375% ropivacaine through the catheter, which was then removed in plan due to aseptic consideration from the surgeon.\u003c/p\u003e\n\u003ch3\u003eContinuous anterior QLB group\u003c/h3\u003e\n\u003cp\u003ePatients were placed in the lateral position, with surgical limb in the upper side. A low-frequency ultrasound transducer was placed at the midpoint between the costal margin and the iliac crest (L4 vertebra level) to identify the classic \"shamrock\" sign. The needle was advanced in-plane from posterior to anterior direction. When the needle penetrated the anterior thoracolumbar fascia between quadratus lumborum and psoas major muscles, a test dose of 3 mL normal saline was injected. The location of the needle tip was good if the injectates diffused beneath the anterior thoracolumbar fascia and pressed down the psoas major or made psoas major ventrally forward, a dose of 0.375% ropivacaine 40 mL was first injected, followed by placement of a catheter (Supplementary Fig.\u0026nbsp;1C and 1D). The catheter was connected to a pump which was programmed the same as that in the continuous supra-inguinal FIB group.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eControl group\u003c/h2\u003e \u003cp\u003ePatients were provided with standard preoperative analgesia, i.e., oxycodone-acetaminophen tablets (each tablet contains oxycodone hydrochloride 5 mg and acetaminophen 325 mg) were administrated every 8 hours. No regional block or catheterization was performed through the perioperative period.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePerioperative management\u003c/h3\u003e\n\u003cp\u003eAt the time of enrolment, baseline pain intensity both at rest and with movement (defined as position changing for sacral care) was assessed with the numeric rating scale (NRS, an 11-point scale where 0\u0026thinsp;=\u0026thinsp;no pain and 10\u0026thinsp;=\u0026thinsp;the worst pain; a difference of \u0026ge;1 point was considered clinically meaningful [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] ). For patients given regional block, dermatomal sensory block in the anterior and lateral thigh were performed by cold sensation testing with an ice cube and pain intensity was re-assessed 1 hour later. Successful block was defined as the simultaneous presence of reduced cold sensation compared to the corresponding area of contralateral leg and a reduction from baseline of more than 1 point of NRS pain score at rest. All enrolled patients were followed up for pain intensity once daily till the day of surgery. Rescue systemic opioids were allowed if the NRS pain score at rest remained \u0026ge;4.\u003c/p\u003e \u003cp\u003eGeneral anesthesia or neuraxial anesthesia was performed at the discretion of anesthesiologists. For patients in the supra-inguinal FIB and anterior QLB groups, 30 ml of 0.375% ropivacaine was injected via the indwelling catheter; the catheter was then removed before surgical disinfection.\u003c/p\u003e \u003cp\u003eAfter surgery, a patient-controlled intravenous analgesic pump (1.25 \u0026micro;g/ml sufentanil) was provided for all enrolled patients and set to deliver 4-mL boluses at a 10-minute lockout interval without background infusion. Non-steroid anti-inflammatory drugs (100 mg flurbiprofen axetil or 40 mg parecoxib sodium, intravenous injection every 12 hours) were prescribed for up to 3 days after surgery, unless there were contraindications. Tramadol, morphine, or oxycodone-acetaminophen tablets could be used as rescue drugs in the ward. Analgesic target was to maintain NRS pain score of \u0026lt;\u0026thinsp;4.\u003c/p\u003e\n\u003ch3\u003eData collection and outcome assessment\u003c/h3\u003e\n\u003cp\u003eBaseline data including demographics, educational years, surgical diagnosis, comorbidities and Charlson Comorbidity Index, important laboratory and echocardiographic results, and American Society of Anesthesiologists classification were collected. Baseline evaluations included frail status, sleep quality, daily activity and mobility before fracture (assessed with the modified Frailty Index, Pittsburgh Sleep Quality Index, Barthel Index and Parker Mobility Scale, respectively). Besides, the risk of death in patients above 70 years were evaluated with the Almelo Hip Fracture Score.\u003c/p\u003e \u003cp\u003eFor patients undergoing spinal anesthesia, pain intensity when changing body position was assessed with the NRS; the satisfaction score of anesthesiologists with patient positioning was evaluated with a 5-point Likert scale. Intraoperative data including type of anesthesia, medications, durations of anesthesia and surgery, type of surgical approach, and intraoperative fluid balance were collected.\u003c/p\u003e \u003cp\u003eAfter surgery, patients were followed up at 6, 24, 48, and 72 hours for pain intensity (both at rest and with movement), opioid consumption, and subjective sleep quality. Quality of recovery at 24 hours after surgery was evaluated with the validated Quality of Recovery-40 (QoR-40) questionnaire with a total score from 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery)[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A minimal difference of 6.3 points was considered clinically important [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Before hospital discharge, daily activity was reassessed with the Barthel Index; hip joint function was evaluated with the modified Harris Hip Score (score ranges from 0 to 91, with higher score indicating better hip function). We also documented complications during hospitalization and length of hospital stay.\u003c/p\u003e \u003cp\u003eAt 90 days after surgery, we contacted patients via telephone. Besides hip joint function assessment, pain and disability was evaluated with the Oxford Hip Score (OHS; score ranges from 0 to 60, with higher score indicating worse health state). Chronic pain was defined as NRS pain score\u0026thinsp;\u0026ge;\u0026thinsp;3 in the surgical area. The vital status and any hospital readmission were recorded.\u003c/p\u003e \u003cp\u003eNerve block-related adverse events, intraoperative arrhythmia, hypotension, hypertension, bradycardia, tachycardia as well as postoperative nausea and vomiting within 72 hours were monitored.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes\u003c/h2\u003e \u003cp\u003eOur primary endpoint was the quality of recovery (assessed with the QoR-40) at 24 hours after surgery. Secondary endpoints included pain intensity at preset timepoints, length of hospital stay, complications during hospital stay, daily activity and hip joint function at hospital discharge, and hip joint function as well as pain and disability at 90 days after surgery. The QoR-40 score at hospital discharge was originally designated as a secondary endpoint but cancelled during the study period to simplify the evaluation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSample size calculation\u003c/h2\u003e \u003cp\u003eIn our preliminary data, the QoR-40 score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) at 24 hours after hip fracture surgery in patients given preoperative anterior QLB and conventional analgesia (each 10 patients) was 180\u0026thinsp;\u0026plusmn;\u0026thinsp;16 and 171\u0026thinsp;\u0026plusmn;\u0026thinsp;14, respectively. We assumed that supra-inguinal FIB would improve the QoR-40 score in a similar magnitude as with anterior QLB. With the significance level set at 0.05 and power at 0.9, the sample size required to detect differences was 47 cases per group. Considering a 10% dropout rate, a total of 159 cases (53 cases per group) was needed. The sample size calculation was performed using PASS software (version 15.0, NCSS PASS, Utah, USA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eOutcome analysis was performed in the intention-to-treat population. For the primary endpoint, analysis was also performed in the per-protocol population, in which case patients with failed block or catheter dislodgement were excluded.\u003c/p\u003e \u003cp\u003eFor the primary endpoint, QoR-40 score at 24 postoperative hours, difference among three groups was assessed with the Kruskal-Wallis test and covariate-adjusted sensitivity analysis was also performed. For secondary endpoints and other analyses, continuous or ranked variables were analyzed using analysis of variance (ANOVA) or Kruskal-Wallis tests; categorical variables were compared using chi-square or Fisher's exact tests; time-to-event variables were assessed with Kaplan-Meier survival analyses and log-rank tests. As exploratory analysis, we also calculated area under curve (AUC) of pain intensity within 72 hours; results among three groups were analyzed with Kruskal-Wallis tests. Missing data was not imputed. A two-sided \u003cem\u003eP\u003c/em\u003e-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003ePairwise comparisons were performed for variables with differences among three groups. The differences between two medians and 95% CIs were calculated with the Hodges-Lehmann estimators. A P-value of less than 0.0167 was considered statistically significant after Bonferroni correction. All statistical analyses were performed with statistical packages R (version 4.3.1, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom September 4, 2020 to July 7, 2023, 314 patients who were admitted for hip fracture surgery were screened. Of these, 189 patients were eligible, and 159 patients were finally enrolled and randomized into the control, continuous supra-inguinal FIB, and continuous anterior QLB groups, with 53 patients in each group. All enrolled patients were included in the intention-to-treat analysis. During the study period, there were 1 block failure (in the anterior QLB group) and 9 unexpected catheter dislocations before surgery (7 in the supra-inguinal FIB group and 2 in the anterior QLB group). These patients were excluded from the per-protocol analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBaseline variables were well balanced among the three groups, except that pain intensity with movement was higher in the supra-inguinal FIB and anterior QLB groups than in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All intraoperative variables were comparable among the three groups, except that patients in the supra-inguinal FIB group had slightly lower lactate level. For patients who were given general anesthesia, those in the anterior QLB group required less sufentanil and dexmedetomidine than in the control group (Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupra-inguinal FIB (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnterior QLB (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (70, 85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (71, 87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (72, 86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (M/F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (22.6)/ 41(77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (30.2)/ 37 (69.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (22.6)/ 41(77.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (6, 15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (6, 15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (6, 12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip fracture type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemur neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (66.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (64.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (66.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntertrochanteric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtrochanteric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (26.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther CNS diseases \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma/chronic bronchitis/COPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (11.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (64.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (67.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (64.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArrythmia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther heart diseases \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (28.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther metabolic diseases \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharlson comorbidity index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA physical classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (71.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (69.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModified Frailty Index (point)\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1, 2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePittsburgh Sleep Quality Index (point)\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (4, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (4, 11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (5, 11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index (point)\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (95, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (90, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (95, 100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParker Mobility Score (point)\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (7, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (5, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (6, 9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlmelo Hip Fracture Score (point)\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (4, 8) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (6, 9) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (5, 9) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime interval from fracture to enrolment (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (26, 144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (23, 81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (29, 74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain intensity at enrolment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS pain score, at rest \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1, 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS pain score, with movement \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (6, 9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal time for continuous block (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are presented as median (Q1, Q3), number (%) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Numbers in square brackets indicate patients with missing data. FIB, fascia iliaca block; QLB, quadratus lumborum block; CNS, central nervous system; COPD, chronic obstruction pulmonary disease; ASA, American Society of Anesthesiologists; NRS: numeric rating scale; NA: not applicable.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003e Included transient ischemic attack, Parkinson's disease, history of neurosurgery.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eb\u003c/sup\u003e Included valve heart disease and permanent pacemaker implantation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ec\u003c/sup\u003e Included hyperlipidemia, hyperuricemia, and thyroid disease.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ed\u003c/sup\u003e Score ranges from 0 to 11, with higher score indicating higher level of frailty.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ee\u003c/sup\u003e Score ranges from 0 to 21, with higher score indicating worse sleep quality.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ef\u003c/sup\u003e Used to assess an individual's independence in activities of daily living (ADLs) by assigning scores to tasks like feeding, bathing, and mobility; score ranges from 0 to 100, with higher scores signify greater self-sufficiency, and lower scores indicate higher dependency.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eg\u003c/sup\u003e A composite measurement of the patient's mobility indoors, outdoors, and during shopping; the total score ranges from 0 to 9, with higher score indicates better ability to move.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eh\u003c/sup\u003e Used to predict mortality of older (\u0026gt;\u0026thinsp;70 years) patients after surgery for hip fracture; score ranges from 3 to 19, with higher score indicating higher risk of mortality.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ei\u003c/sup\u003e An 11-point scale where 0\u0026thinsp;=\u0026thinsp;no pain and 10\u0026thinsp;=\u0026thinsp;the worst pain.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe QoR-40 score at 24 hours after surgery was median 184 [IQR 176 to 187] in the control group, 185 [178 to 191] in the supra-inguinal FIB group, and 188 [182 to 191] in the anterior QLB group (P\u0026thinsp;=\u0026thinsp;0.042). Pairwise comparison showed that the QoR-40 score was higher in the anterior QLB group than in the control group (median difference 4; 95% CI 1 to 7; P\u0026thinsp;=\u0026thinsp;0.008), but the difference was not clinically important (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Per-protocol analysis also showed similar results.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eComplications during hospital stay, length of hospital stay, Barthel index as well as hip function results at hospital discharge and 90 days after surgery did not differ among the three groups (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Supplementary Table S2).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEfficacy outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupra-inguinal FIB (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnterior QLB (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary endpoint\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality of recovery at 24 hours (point)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184 (176, 187)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185 (178, 191) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e188 (182, 191)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.042\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality of recovery at 24 hours (point, PP analysis)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184 (176, 187) (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185 (178, 191) (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e188 (182, 191) (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSecondary endpoints\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications during hospital stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal length of hospital stay (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (7, 11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (8, 14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (8, 13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay after surgery (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (5, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6, 11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (6, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn the day of hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index (point)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (60, 80) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (50, 75) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (55, 80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModified Harris Hip Score (point)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (44, 58) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (45, 58) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (46, 59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt 90 days after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index (point)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (85, 95) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (75, 95) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (83, 100) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModified Harris Hip Score (point)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (59, 76) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (60, 79) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (61, 80) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxford Hip Score (point)\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (22, 31) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (20, 34) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (19, 32) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther endpoints and exploratory analysis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn patients received axial anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfactory score with lateral position \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3, 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (5, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfactory ratio with lateral position \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (96.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU admission after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring 72 postoperative hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUC of pain score at rest (point\u0026sdot;h)\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (0, 114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0, 76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0, 30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUC of pain score with movement (point\u0026sdot;h)\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e246 (192, 312)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192 (140, 263)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168 (114, 216)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCumulative sufentanil equivalent (\u0026micro;g)\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.0 (20.0, 63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.0 (15.0, 65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.8 (10.0, 45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjective sleep quality (score) \u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst postoperative night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1, 7) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond postoperative night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (2, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird postoperative night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality within 90 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.9) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0 ) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.9) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission within 90 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (13.5) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10.0) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (13.5) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic pain at 90 days after surgery \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.8) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8.0) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.9) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as median (Q1, Q3), number (%) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Numbers in square brackets indicate patients with missing data. IQR, interquartile range; FIB, fascia iliaca block; QLB, quadratus lumborum block; PP, per-protocol; AUC, area under curve; PCA, patient-controlled analgesia.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e Assessed with QoR-40 scale, which contains 40 items and its scores ranges from 0 to 200, with higher scores indicating better postoperative recovery.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003e Used to assess an individual's independence in activities of daily living (ADLs) by assigning scores to tasks like feeding, bathing, and mobility; score ranges from 0 to 100, with higher scores signify greater self-sufficiency, and lower scores indicate higher dependency.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ec\u003c/sup\u003e Used to assess an individual's hip function through pain (44 points), as well as mobility and walking function (47 points), the latter aspects included limp gait (11 points), walking support (11 points), walking distance (11 points), ability for stairs (4 points), socks or shoes (4 points), sitting (5 points) and public transportation (1 point). In total, modified Harris hip score ranges from 0 to 91, with higher scores indicating better hip function.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ed\u003c/sup\u003e The Oxford hip score (OHS) is a reliable, joint-specific, self-administered questionnaire for assessing hip pain and disability with 12-item and a total value of 60 scores, where the higher the score, the worse the health state.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ee\u003c/sup\u003e Satisfaction scale of anesthesiologists who performed the spinal anesthesia, assessed with a five-point Likert scale where 1\u0026thinsp;=\u0026thinsp;very dissatisfied, 2\u0026thinsp;=\u0026thinsp;dissatisfied, 3\u0026thinsp;=\u0026thinsp;moderate, 4\u0026thinsp;=\u0026thinsp;satisfied, 5\u0026thinsp;=\u0026thinsp;very satisfied. A scale of 4 or higher indicates satisfied with the lateral position.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ef\u003c/sup\u003e Pain intensity was assessed with the numeric rating scale where 0 indicates the no pain and 10 indicates the worst pain. AUC calculated during 72 postoperative hours.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eg\u003c/sup\u003e Indicated the total sufentanil equivalent consumed during 72 postoperative hours (including PCA pump). 1 Tylox tablet (containing 5 mg oxycodone)\u0026thinsp;=\u0026thinsp;10 mg morphine (PO)\u0026thinsp;=\u0026thinsp;3.3 mg morphine (IV)\u0026thinsp;=\u0026thinsp;3.3 \u0026micro;g sufentanil (IV). 100 mg tramadol (PO)\u0026thinsp;=\u0026thinsp;33.3 mg tramadol (IV)\u0026thinsp;=\u0026thinsp;3.3 mg morphine (IV)\u0026thinsp;=\u0026thinsp;3.3 \u0026micro;g sufentanil (IV).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eh\u003c/sup\u003e Assessed with the numeric rating scale where 0 indicates the best sleep quality and 10 indicates the worst sleep quality.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ei\u003c/sup\u003e Defined as NRS pain score\u0026thinsp;\u0026ge;\u0026thinsp;3 in the surgical area at 90 days postoperatively.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBefore surgery, pain intensity both at rest and with movement was lower in the two regional block groups at 1 hour and 1 day post-enrolment than in the control group (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB, Supplementary Table S3). After surgery, pain intensity at rest was lower in the supra-inguinal FIB group at 72 hours (median differences 0 point; P\u0026thinsp;=\u0026thinsp;0.016) and in the anterior QLB group at 24, 48, and 72 hours than in the control group (median differences 0 point; P\u0026le;0.006; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA; Supplementary Table S3), but the differences were not clinically important; pain intensity with movement was lower in the anterior QLB group at 6, 24, 48, and 72 hours than in the control group (median differences \u0026minus;\u0026thinsp;1 point; P\u0026le;0.011; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB; Supplementary Table S3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eExploratory analysis showed that, for patients who received neuraxial anesthesia, anesthesiologists were more satisfied with lateral positioning in the two nerve-block groups than in the control group, no matter if analyzed with the median difference of satisfactory score or the relative risk of satisfactory ratio. Among all patients, AUC of pain score both at rest and with movement within 72 hours after surgery were lower in the anterior QLB group than in the control group (at rest: median difference \u0026minus;\u0026thinsp;21 point\u0026sdot;h; 95% CI -66 to 0; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; with movement: median difference \u0026minus;\u0026thinsp;78 point\u0026sdot;h; 95% CI -117 to -40; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); there were no significant differences between the supra-inguinal FIB and control groups and between the anterior QLB and supra-inguinal FIB groups (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Regarding to the difference in the pain score with movement at baseline among three groups and its potential influence to QoR-40 score, sensitivity analysis was performed with a linear regression model for the rank-transformed QoR-40 score, in which the pain score with movement at baseline was set as the covariate. Results indicated that the between-group differences remained consistent both before and after covariate adjustment (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePairwise Comparation of QoR-40 and Pain Score After Surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSupra-inguinal FIB \u003cem\u003evs.\u003c/em\u003e control\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAnterior QLB \u003cem\u003evs.\u003c/em\u003e control\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAnterior QLB \u003cem\u003evs.\u003c/em\u003e supra-inguinal FIB\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD or RR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMD or RR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMD or RR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary endpoint\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality of recovery at 24 h (point)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (-1, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (-1, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality of recovery at 24 h (point, PP analysis) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (-1, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (-2, 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther endpoints and exploratory analysis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt lateral position for neuraxial anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfactory score (point)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfactory ratio \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.65 (1.25, 2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.60 (1.21, 2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.97 (0.91, 1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUC of pain score during postoperative 72 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt rest (point\u0026sdot;h) \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-9 (-51, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-21 (-66, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (-9, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith movement (point\u0026sdot;h) \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-45 (-81, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-78 (-117, -40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-34 (-69, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank-transformed quality of recovery at 24 h (unadjusted)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (-6, 30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (6, 39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (-7, 29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank-transformed quality of recovery at 24 h (adjusted for baseline NRS pain score with movement)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (-11, 28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (2, 39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (-6, 30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eP\u003c/em\u003e values in bold indicate\u0026thinsp;\u0026lt;\u0026thinsp;0.0167 is considered statistically significant after Bonferroni correction. FIB, fascia iliaca block; QLB, quadratus lumborum block; MD, median difference; CI, confidence interval; RR, relative risk; AUC, area under curve.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e Assessed with QoR-40 scale, which contains 40 items and its scores range from 0 to 200, with higher scores indicating better postoperative recovery.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003e Satisfaction scale of anesthesiologists who performed the spinal anesthesia, assessed with a five-point Likert scale where 1\u0026thinsp;=\u0026thinsp;very dissatisfied, 2\u0026thinsp;=\u0026thinsp;dissatisfied, 3\u0026thinsp;=\u0026thinsp;moderate, 4\u0026thinsp;=\u0026thinsp;satisfied, 5\u0026thinsp;=\u0026thinsp;very satisfied. A scale of 4 or higher indicates satisfied with the lateral position.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ec\u003c/sup\u003e Pain intensity was assessed with the numeric rating scale where 0 indicates the no pain and 10 indicates the worst pain. AUC calculated during 72 postoperative hours.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdverse events did not differ among three groups. No severe adverse events occurred during the study period (Supplementary Table S4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis randomized trial showed that, in patients admitted for hip fracture surgery, preoperative continuous anterior QLB from hospital admission produced a significant yet no clinically important improvement in quality of recovery at 24 postoperative hours, whereas continuous supra-inguinal FIB did not. Both approaches of continuous nerve block improved preoperative analgesia and satisfactory score/ratio of anesthesiologists with lateral position for spinal anesthesia; continuous anterior QLB provided better postoperative analgesia both at rest and with movement within 72 postoperative hours.\u003c/p\u003e \u003cp\u003eTill now, the optimal regional block for perioperative analgesia in hip fracture patients remains to be determined[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Regional anesthesia for hip surgery should block the subcostal nerve together with the lumbar and sciatic plexus [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], whereas analgesia mainly focuses on the blockade of lumbar plexus or its terminal branches as they innervate the anterior hip joint capsule where nociceptive fibers are predominantly present[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Based on these considerations, supra-inguinal FIB and anterior QLB are used for analgesia after hip surgery. Indeed, previous studies showed that both supra-inguinal FIB [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and anterior QLB [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] provided effective analgesia, as manifested by lowered pain score and reduced opioid consumption when compared with no block in hip surgery patients. On the other hand, negative results also exist, i.e., neither block improved analgesia when compared with no block [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, a bolus dose of local anesthetics was injected via the indwelling catheter before surgery in regional block groups, resembling the single-shot technique in previous studies. We found that patients given anterior QLB had better postoperative analgesia, thus resulted in slightly improved quality of recovery at 24 hours after surgery when compared with no block. Our result was consistent with a recent meta-analysis, which showed that the effect of anterior QLB lasted for up to 24 hours after surgery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This was because anterior QLB was performed at L4 vertebra level in our patients, with local anesthetics diffused between the anterior thoracolumbar fascia and the psoas major muscle[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This technique stably blocks the femoral and lateral femoral cutaneous nerves and potentially blocks the lumbar plexus [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our results, however, supra-inguinal FIB did not significantly improve analgesia after surgery and, thus, did not change quality of recovery at 24 hours after surgery. Our results were contradictory to previous findings that supra-inguinal FIB provided superior [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] or comparable analgesic effect when compared with QLB [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], but was in line with a recent trial which showed that ultrasound-guided supra-inguinal FIB did not significantly reduce opioid consumption compared with sham block [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Potential reasons leading to these inconsistences are not clear but may be related to the differences of nerve block techniques and surgical types.\u003c/p\u003e \u003cp\u003eWe did not find differences in terms of other secondary endpoints among the three groups. This was understandable since we only had 53 patients in each group. A recent meta-analysis also reported similar results, i.e. preoperative peripheral nerve block relieved pain intensity in hip fracture patients but did not change length of hospital stay [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. More studies are needed to clarify the effects of preoperative nerve block on perioperative outcomes in this patient population.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, we didn't assess the QoR-40 score preoperatively, preventing adjustment the results for preoperative status. The observed median difference of QoR-40 score at postoperative 24 hour between QLB and conrol group is below the well recognized MCID ( about 6.3 point), so the clinical meaning of this result is limited despite statistical significant. Second, we did not standardize anesthetic methods for hip fracture surgery due to diverse conditions of patients. However, it was proved that the anesthetic method per se did not affect patients' clinical outcomes [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Third, the catheters were not retained for postsurgical analgesia due to strict disinfection of the operation area. Fourth, based on the present QoR-40 score of the three groups, we did a post-hoc power analysis with one-way analysis and found statistical power of this paper is insufficient. To achieve a statistical power of 0.8, a sample size of 432 cases will be required in the future study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAmong patients who were admitted for hip fracture surgery, preoperative continuous anterior QLB started from hospital admission improved pre- and postoperative analgesia and slightly improved early postoperative recovery when compared with no block, whereas continuous supra-inguinal FIB only improved preoperative analgesia.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe trial protocol was approved by the Biomedical Research Ethics Committee of Peking University First Hospital (Approval Number: 2020\u0026thinsp;\u0026minus;\u0026thinsp;222) and registered with Chinese Clinical Trial Registry on September 2, 2020 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.chictr.org.cn\u003c/span\u003e\u003cspan address=\"http://www.chictr.org.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, ChiCTR2000037857) before the first enrolment started (September 4, 2020). This study adhered to the principles of the Declaration of Helsinki.Written informed consent was obtained from each participant.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis trial was supported by the Foundation for the National Key Research and Development Program of China (Research on Comprehensive Technical Scheme for Perioperative Management of Elderly Patients).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConcept and design: X L, H Z, D-J Z; Acquisition, analysis, or interpretation of data: Z-Z X, Y-T L, H-F W, D-M N; Supervision of the trial: D-M N, H Z, D-J Z; Drafting of the manuscript: X L, Z-Z X; Critical review of the manuscript: D-X W; All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe sincerely appreciate the surgeon team (Yong-Ping Cao; Xin Yang; Yi-Lin Ye; Zhen-Ning Liu, Zhi-Chao Meng; Heng Liu; Hao Wu) in orthopedic department of Peking University First Hospital for their good cooperation with us during this trial.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset supporting the conclusions of this article is uploaded in the Supplementary material (filename: dataset.xlsx).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBraithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003;51(3):364\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhandari M, Swiontkowski M. Management of Acute Hip Fracture. N Engl J Med. 2017;377(21):2053\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuhe MM, Veldhuis LI, Azijli-Abdelloui K, Schepers T, Ridderikhof ML. Prehospital analgesia in suspected hip fracture patients: adherence to national prehospital pain management guidelines. Eur J Trauma Emerg Surg. 2024;50(3):937\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson C, Brienza VJM, Sandre A, Caine S, Borgundvaag B, McLeod S. Risk factors associated with acute in-hospital delirium for patients diagnosed with a hip fracture in the emergency department. Cjem. 2018;20(6):911\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eExsteen OW, Svendsen CN, Rothe C, Lange KHW, Lundstr\u0026oslash;m LH. Ultrasound-guided peripheral nerve blocks for preoperative pain management in hip fractures: a systematic review. BMC Anesthesiol 2022, 22(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOng T, Vindlacheruvu M. A commentary update on NICE CG124. Hip fracture:management (2023). Age Ageing 2023, 52(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuay J, Parker MJ, Griffiths R, Kopp SL. Peripheral Nerve Blocks for Hip Fractures: A Cochrane Review. Anesth Analg. 2018;126(5):1695\u0026ndash;704.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, Jeng CL, Nelson BP, Rosenblatt MA, Silverstein JH, et al. Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial. J Am Geriatr Soc. 2016;64(12):2433\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, Caerts B, Seynaeve P, Hadzic A, Van de Velde M. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Reg Anesth Pain Med 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames M, Bentley RA, Womack J, Goodman BA. Safety profile and outcome after ultrasound-guided suprainguinal fascia iliaca catheters for hip fracture: a single-centre propensity-matched historical cohort study. Can J Anaesth. 2022;69(9):1139\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu J, Qin Y, She H, Ma R. Review of the injectate dispersion pattern during anterior quadratus lumborum block. Med (Baltim). 2022;101(48):e32038.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKukreja P, MacBeth L, Sturdivant A, Morgan CJ, Ghanem E, Kalagara H, Chan VWS. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Reg Anesth Pain Med 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolania Gutierrez JJ, Ben-David B, Rest C, Grajales MT, Khetarpal SK. Quadratus lumborum block type 3 versus lumbar plexus block in hip replacement surgery: a randomized, prospective, non-inferiority study. Reg Anesth Pain Med. 2021;46(2):111\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMyles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017;118(3):424\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGornall BF, Myles PS, Smith CL, Burke JA, Leslie K, Pereira MJ, Bost JE, Kluivers KB, Nilsson UG, Tanaka Y, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth. 2013;111(2):161\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMyles PS, Myles DB, Galagher W, Chew C, MacDonald N, Dennis A. Minimal Clinically Important Difference for Three Quality of Recovery Scales. Anesthesiology. 2016;125(1):39\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayashi M, Yamamoto N, Kuroda N, Kano K, Miura T, Kamimura Y, Shiroshita A. Peripheral Nerve Blocks in the Preoperative Management of Hip Fractures: A Systematic Review and Network Meta-Analysis. Ann Emerg Med. 2024;83(6):522\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin. 2018;36(3):403\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShort AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018;43(2):186\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A, Vangsness CT Jr.. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012;22(1):75\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, Lambrecht S, Croes K, Pottel H, Van de Velde M. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty. Reg Anesth Pain Med. 2017;42(3):327\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGola W, Bialka S, Owczarek AJ, Misiolek H. Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study. Int J Environ Res Public Health 2021, 18(9).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoo CH, Ahn S, Na HS, Ryu JH, Shin HJ. Efficacy of quadratus lumborum block for analgesia in adult participants undergoing hip surgery: A meta-analysis of randomized controlled trials. J Clin Anesth. 2021;75:110560.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSafa B, Trinh H, Lansdown A, McHardy PG, Gollish J, Kiss A, Kaustov L, Choi S. Ultrasound-guided suprainguinal fascia iliaca compartment block and early postoperative analgesia after total hip arthroplasty: a randomised controlled trial. Br J Anaesth. 2024;133(1):146\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehera BK, Misra S, Sarkar S, Mishra N. A Systematic Review and Meta-Analysis of Efficacy of Ultrasound-Guided Single-Shot Quadratus Lumborum Block for Postoperative Analgesia in Adults Following Total Hip Arthroplasty. Pain Med. 2022;23(6):1047\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShao P, Li H, Shi R, Li J, Wang Y. Understanding fascial anatomy and interfascial communication: implications in regional anesthesia. J Anesth. 2022;36(4):554\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016;117(3):387\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdhikary SD, El-Boghdadly K, Nasralah Z, Sarwani N, Nixon AM, Chin KJ. A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers. Anaesthesia. 2017;72(1):73\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRefaat S, M MA, Elsherief IME, Mohamed MM. Ultrasound-guided fascia iliaca block versus quadratus lumborum block for perioperative analgesia in patients undergoing hip surgery. A randomised controlled trial. Anaesthesiol Intensive Ther. 2023;55(3):212\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirkheshti A, Hashemian M, Abtahi D, Shayegh S, Manafi-Rasi A, Sayadi S, Memary E, Karami N, Rostamian B, Shakeri A. Quadratus Lumborum Block versus Fascia Iliaca Compartment Block for Acetabular Fracture Surgery by Stoppa Method: A Double-Blind, Randomized, Noninferiority Trial. Pain Res Manag. 2024;2024:3720344.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, Sieber F, Magaziner J, Marcantonio ER, Mehta S, et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021;385(22):2025\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Supra-inguinal fascia iliaca block, Anterior quadratus lumborum block, Hip fracture, Quality of recovery, Analgesia","lastPublishedDoi":"10.21203/rs.3.rs-8504943/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8504943/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEffects of preoperative continuous regional block on perioperative analgesia and postoperative recovery in hip fracture patients remain to be determined. This randomized trial was designed to investigate the impact of continuous supra-inguinal fascia iliaca block (FIB) or anterior quadratus lumborum block (QLB) on quality of recovery after hip fracture surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eEligible patients were randomized to receive continuous supra-inguinal FIB, continuous anterior QLB, or conventional analgesia (no block; control group). Continuous regional blocks were initiated at hospital admission and induced with 40 ml of 0.375% ropivacaine and maintained with 5 ml/h of 0.2% ropivacaine, and reinforced with 30 ml of 0.375% ropivacaine before surgery. The primary endpoint was quality of recovery (QoR) assessed with the QoR-40 questionnaire at 24 hours after surgery. Secondary endpoints included pain intensity before and after surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 159 patients were randomized, with 53 patients in each group. The QoR-40 score at 24 hours was median 184 [IQR 176 to 187] in the control group, 185 [178 to 191] with supra-inguinal FIB, and 188 [182 to 191] with anterior QLB (P\u0026thinsp;=\u0026thinsp;0.042), respectively; the QoR-40 score was higher in the anterior QLB group than in the control group (median difference 4; 95% CI 1 to 7; P\u0026thinsp;=\u0026thinsp;0.008) although this difference was not clinically important. Both regional blocks alleviated pain intensity before surgery, but only anterior QLB provided better analgesia for up to 72 postoperative hours.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePreoperative continuous anterior QLB improved perioperative analgesia and slightly improved early postoperative recovery whereas continuous supra-inguinal FIB did not.\u003c/p\u003e\u003ch2\u003eTrial Registration\u003c/h2\u003e \u003cp\u003ewww.chictr.org.cn,ChiCTR2000037857\u003c/p\u003e","manuscriptTitle":"Impact of preoperative continuous supra-inguinal fascia iliaca block or anterior quadratus lumborum block versus conventional analgesia on quality of recovery after hip fracture surgery: A three-arm randomized clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 12:23:44","doi":"10.21203/rs.3.rs-8504943/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-27T08:46:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-20T03:02:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-18T01:51:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87426921839863078561144574451613383304","date":"2026-01-18T00:50:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295315169243934081350263654132701675092","date":"2026-01-16T13:23:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180291987854349417564044120050091821010","date":"2026-01-16T11:07:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-16T04:19:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-15T23:36:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-07T08:55:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T07:13:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2026-01-07T07:00:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75c6dfcf-b2e7-42ef-8c7e-7118831563f9","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:01:59+00:00","versionOfRecord":{"articleIdentity":"rs-8504943","link":"https://doi.org/10.1186/s12871-026-03696-0","journal":{"identity":"bmc-anesthesiology","isVorOnly":false,"title":"BMC Anesthesiology"},"publishedOn":"2026-02-23 15:57:53","publishedOnDateReadable":"February 23rd, 2026"},"versionCreatedAt":"2026-01-20 12:23:44","video":"","vorDoi":"10.1186/s12871-026-03696-0","vorDoiUrl":"https://doi.org/10.1186/s12871-026-03696-0","workflowStages":[]},"version":"v1","identity":"rs-8504943","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8504943","identity":"rs-8504943","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}