analgesia; evidence‐based medicine; pain; systematic review; total hip arthroplasty
Abstract :
[en] [en] INTRODUCTION: The Procedure Specific Postoperative Pain Management (PROSPECT) collaboration develops evidence-based recommendations integrating analgesic efficacy, safety and functional recovery. Since publication of the 2021 PROSPECT guidelines for total hip arthroplasty, new evidence, particularly on motor-sparing regional techniques, has emerged. This systematic review updates the 2021 recommendations for postoperative pain management after elective primary total hip arthroplasty.
METHODS: Databases were searched systematically for randomised controlled trials and systematic reviews published between January 2020 and June 2024 evaluating peri-operative analgesic or surgical interventions for total hip arthroplasty. Studies involving non-randomised designs or lacking validated pain outcomes were not included. Evidence was synthesised according to PROSPECT methodology, focusing on pain within 24 h; opioid consumption; functional recovery; and adverse effects. Recommendations were graded by expert consensus.
RESULTS: A total of 103 studies were included. Core recommendations remain unchanged: scheduled paracetamol and non-steroidal anti-inflammatory drugs, combined with a single intravenous dose of dexamethasone (≤ 10 mg). Low-dose intrathecal morphine (0.1 mg) may be considered with spinal anaesthesia in hospitalised patients. Among regional techniques, supra-inguinal fascia iliaca compartment block and pre-operative pericapsular nerve group block provided the most consistent analgesia. Quadratus lumborum and lumbar erector spinae plane blocks showed inconsistent efficacy and increased risk of motor weakness and are not recommended. Single-shot local infiltration analgesia remains an alternative when regional techniques are unavailable.
DISCUSSION: In addition to previous recommendations, supra-inguinal fascia iliaca compartment block and pre-operative pericapsular nerve group block are recommended as preferred regional techniques for total hip arthroplasty, with single-shot local infiltration analgesia as an alternative when regional anaesthesia is not feasible. [en] [en] WHAT WE DID: A group of researchers looked at all the best available studies about pain relief after hip replacement surgery. They reviewed research published since 2020 and combined the findings to update earlier recommendations on how to manage pain after surgery.
WHY DID WE DO IT: Hip replacement surgery can be painful, and good pain relief helps people recover more quickly and comfortably. New research has become available in recent years, so the researchers wanted to find out which treatments work best and update advice for doctors and patients.
WHAT WE FOUND: The researchers found that regular pain medicines, such as paracetamol and anti‐inflammatory drugs, should still be used as the main treatment after hip replacement surgery. A steroid medicine called dexamethasone may also help reduce pain. Some types of nerve blocks around the hip were found to work well and are recommended when possible. However, other nerve block techniques did not show clear benefits and are not routinely recommended. Overall, the updated recommendations aim to provide safe and effective pain relief to help patients recover after hip replacement surgery.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Carella, Michele ✱; Université de Liège - ULiège > Département des sciences cliniques
Bugada, Dario ✱; Department of Emergency and Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
Van de Velde, Marc ; Department of Cardiovascular Sciences, KU Leuven and Department of Anesthesiology, UZ Leuven, Leuven, Belgium
Beloeil, Helene; Service d'Anesthésie Réanimation et Médecine Péri-opératoire, CHU Rennes, Inserm Numecan, Université Rennes, Rennes, France
Albrecht, Eric ; Department of Anesthesiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
Lavandhomme, Patricia; Department of Anesthesiology and Perioperative Pain Service, Cliniques Universitaires St Luc, University Catholic of Louvain, Brussels, Belgium
Raeder, Johan; Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway and Division of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
Joshi, Girish P ; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
PROSPECT Working Group of the European Society of Regional Anesthesia and Pain Therapy
✱ These authors have contributed equally to this work.
Language :
English
Title :
PROSPECT guideline for total hip arthroplasty: updated systematic review and procedure-specific postoperative pain management recommendations.
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