University of Nebraska Medical Center, USA

The most recent Total Hip Arthroplasty (THA) recommendations by the PROSPECT working group update previous work published in 2005 and updated 2010. We performed a systematic literature review of randomized controlled trials and meta-analyses published between July 2010 and December 2019, and found 521 studies, of which 108 randomized studies and 21 meta-analyses were finally included. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, regional anesthesia in form of select peripheral nerve blocks, single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia were also found to decrease pain. Regional variation in use (more nerve blocks in Europe, more LIA in the United States) is noteworthy. Given a risk-benefit analysis, the PROSPECT group does not recommend use of femoral nerve blocks, epidural anesthesia, and gabapentinoids. The use of intrathecal morphine, similarly, should be subjected to a thorough risk-benefit analysis.

References

1. Anger M, Valovska T, Beloeil H, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021;76:1082–97.