The End of "Deep Blocks" in THA: Why PAI and Fascia Iliaca Blocks Win
A systematic review of 11 high-quality randomized clinical trials reveals why periarticular infiltration outperforms regional nerve blocks in primary THA.
Total hip arthroplasty (THA) has been referred to as one of the most successful procedures in all of medicine due to its ability to restore a patient’s quality of life and functional status. Orthopedic surgeons routinely use multimodal analgesia to manage the postoperative pain associated with THA. Although oral and intravenous medications are commonly used in a multimodal analgesic protocol, the injection of local anesthetic as a regional nerve block or periarticular local anesthetic infiltration (PAI) is meant to reduce the transmission of pain signals associated with neuropathic pain.
A variety of regional nerve blocks have been described around the hip joint to provide analgesia after THA, with fascia iliaca, lumbar plexus, and quadratus lumborum blocks among the most commonly used. Utilization of regional nerve blocks for THA must balance the risks of motor blockade while considering the individual risk associated with each type of regional nerve block.
