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 pain-control techniques (nerve blocks, periarticular injection, intrathecal morphine, and combinations) 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, though intrathecal morphine (ITM) and iliopsoas block plus periarticular infiltration reduced 24-hour opioid consumption, and the pericapsular nerve group (PENG) block and ITM shortened hospital length of stay.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis challenges current PROSPECT guideline recommendations by showing that many widely used blocks for THA do not clear the bar for clinically meaningful pain relief, which should reshape how residents think about perioperative analgesia choices.
Conclusion strengthPotentially practice-changing
Contradicts current practice and patient-important outcome, offset by effect below the MCID on VAS pain score (0-10) and 24-hour opioid consumption (mg mor and no power calculation.
Presenting this at rounds? Start here
- ?The 24-hour opioid consumption outcome had very high heterogeneity (tau-squared 9.19) and the IPB+PAI group showing a clinically meaningful benefit included only 40 patients; how much should these factors temper confidence in the headline findings?
- ?Given that no technique meaningfully reduced POD1 pain but PENG and ITM shortened length of stay and improved mobilization, how should a surgeon weigh these different outcomes when selecting an analgesic strategy, especially considering ITM's opioid-related side-effect profile?