Bone & Joint Open · IF 2.8 · July 21, 2026 · LoE I
Comparative efficacy of analgesic techniques in total hip arthroplasty
Tim Cheok, Morgan Berman, William Jordan, A D Beveridge, Thomas Smith, Craig Morrison, Mehul Mayank, Ruurd L. Jaarsma, Job N. Doornberg — University of Groningen
This network meta-analysis pooled 112 randomized trials to compare more than a dozen regional analgesic techniques (nerve blocks, fascial plane blocks, intrathecal morphine, periarticular injection, and placebo) after total hip arthroplasty, using minimal clinically important difference (MCID) thresholds rather than statistical significance alone. No single technique produced a clinically meaningful reduction in postoperative day 1 pain scores, but intrathecal morphine and iliopsoas block plus periarticular injection reduced 24-hour opioid consumption, and pericapsular nerve group (PENG) block and intrathecal morphine shortened time to mobilization and hospital length of stay compared with placebo.
AI summary · from the full text · reviewed before publishing
Why it mattersThis challenges the current PROSPECT guideline emphasis on femoral, fascia iliaca, and lumbar plexus blocks by showing that no regional technique meaningfully reduces early pain, while newer motor-sparing blocks like PENG may better support enhanced-recovery goals such as early mobilization and discharge.
Conclusion strengthPotentially practice-changing
Contradicts current practice and patient-important outcome, offset by effect below the MCID on Visual Analogue Scale (0-10) pain score and no power calculation.
Presenting this at rounds? Start here
- ?The opioid consumption outcome showed substantial heterogeneity (tau-squared 9.19) likely from differing postoperative regimens and morphine-equivalent conversion formulas, and the IPB+PAI comparison was based on only 40 patients; how much should this temper confidence in the 'clinically meaningful' opioid-sparing findings for ITM and IPB+PAI?
- ?Given that no technique met the MCID for day-1 pain but PENG and intrathecal morphine improved mobilization and length of stay, how should anesthesiologists weigh functional recovery outcomes versus analgesic potency when selecting a block for an enhanced-recovery THA pathway?