Glucocorticoid-Enhanced Fascial Plane and Peripheral Nerve Blocks Versus Periarticular and Local Infiltration Analgesia in Total Hip Arthroplasty: A Prospective Randomized Controlled Trial.
Jinlei Li, Lee E Rubin, Ramya Krishnan et al.
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In 30 seconds
This prospective randomized controlled trial compared anterior quadratus lumborum plus lateral femoral cutaneous nerve blocks (aQLB+LFCNB) with periarticular and local infiltration analgesia (PALIA) in patients undergoing total hip arthroplasty. Both approaches included ropivacaine and dual glucocorticoids. Among 188 patients in the final analysis, postoperative day 1 opioid consumption did not differ significantly: median oral morphine milligram equivalents were 29.84 with aQLB+LFCNB and 30.50 with PALIA (p = 0.57). Pain and functional recovery outcomes were also similar; fasting glucose on postoperative day 1 was lower with aQLB+LFCNB.
Key findings
- Postoperative day 1 opioid consumption was similar: median 29.84 oMME with aQLB+LFCNB versus 30.50 with PALIA (p = 0.57).
- Fasting glucose on postoperative day 1 was lower with aQLB+LFCNB than PALIA: median 141.50 versus 153.00 mg/dL (p = 0.003).
- No significant differences were observed in other secondary outcomes, including pain scores and functional recovery measures.
Why it matters
The trial directly compares two multimodal analgesic approaches for total hip arthroplasty, with both incorporating dual glucocorticoids. Its findings suggest that the nerve-block strategy did not provide a measurable advantage over infiltration analgesia for opioid use, pain, or functional recovery in this study. The glucose difference is a secondary finding and should be interpreted alongside the otherwise similar outcomes.
What to keep in mind
The findings apply to the tested regimens, both of which included dual glucocorticoids; the abstract does not establish whether results generalize to approaches without them.