TY - JOUR
T1 - The Efficacy and Safety of Regional Nerve Blocks in Total Hip Arthroplasty
T2 - Systematic Review and Direct Meta-Analysis
AU - Fillingham, Yale A.
AU - Hannon, Charles P.
AU - Kopp, Sandra L.
AU - Sershon, Robert A.
AU - Stronach, Benjamin M.
AU - Meneghini, R. Michael
AU - Abdel, Matthew P.
AU - Griesemer, Margaret E.
AU - Austin, Matthew S.
AU - Casambre, Francisco D.
AU - Woznica, Anne
AU - Nelson, Nicole
AU - Hamilton, William G.
AU - Della Valle, Craig J.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Background: Regional nerve blocks may be used as a component of a multimodal analgesic protocol to manage postoperative pain after primary total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after THA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published prior to March 24, 2020 on fascia iliaca, lumbar plexus, and quadratus lumborum blocks in primary THA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks. Results: An initial critical appraisal of 3,382 publications yielded 11 publications representing the best available evidence for an analysis. Fascia iliaca, lumbar plexus, and quadratus lumborum blocks demonstrate the ability to reduce postoperative pain and opioid consumption. Among the available comparisons, no difference was noted between a regional nerve block or local periarticular anesthetic infiltration regarding postoperative pain and opioid consumption. Conclusion: Local periarticular anesthetic infiltration should be considered prior to a regional nerve block due to concerns over the safety and cost of regional nerve blocks. If a regional nerve block is used in primary THA, a fascia iliaca block is preferred over other blocks due to the differences in technical demands and risks associated with the alternative regional nerve blocks.
AB - Background: Regional nerve blocks may be used as a component of a multimodal analgesic protocol to manage postoperative pain after primary total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after THA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published prior to March 24, 2020 on fascia iliaca, lumbar plexus, and quadratus lumborum blocks in primary THA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks. Results: An initial critical appraisal of 3,382 publications yielded 11 publications representing the best available evidence for an analysis. Fascia iliaca, lumbar plexus, and quadratus lumborum blocks demonstrate the ability to reduce postoperative pain and opioid consumption. Among the available comparisons, no difference was noted between a regional nerve block or local periarticular anesthetic infiltration regarding postoperative pain and opioid consumption. Conclusion: Local periarticular anesthetic infiltration should be considered prior to a regional nerve block due to concerns over the safety and cost of regional nerve blocks. If a regional nerve block is used in primary THA, a fascia iliaca block is preferred over other blocks due to the differences in technical demands and risks associated with the alternative regional nerve blocks.
KW - fascia iliaca block
KW - lumbar plexus block
KW - nerve block
KW - quadratus lumborum block
KW - total hip arthroplasty
KW - total joint arthroplasty
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U2 - 10.1016/j.arth.2022.04.035
DO - 10.1016/j.arth.2022.04.035
M3 - Article
C2 - 36162924
AN - SCOPUS:85138337052
SN - 0883-5403
VL - 37
SP - 1922-1927.e2
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 10
ER -