Comparative efficacy of analgesic techniques in total hip arthroplasty
Bone & Joint Open · 21 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
This challenges the assumption, embedded in current PROSPECT guidelines, that specific regional blocks meaningfully reduce pain after hip arthroplasty, and instead points clinicians toward opioid-sparing and discharge-related benefits rather than pain control itself.
The evidence
This network meta-analysis pooled 112 randomised trials comparing 23 different regional analgesic techniques (nerve blocks, periarticular injection, intrathecal morphine, and combinations) against placebo in patients undergoing total hip arthroplasty. On the primary outcome, postoperative day 1 pain score, several techniques reached statistical significance versus placebo but none crossed the pre-defined MCID of 1.86 points on the VAS, meaning no technique produced a pain reduction patients would actually notice; secondary analyses found intrathecal morphine and iliopsoas block plus periarticular injection reduced opioid use, and intrathecal morphine and pericapsular nerve group (PENG) block shortened hospital stay.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Meta-analysis of RCTs
Methods at a glance
Recorded assessment- Comprehensive literature searchNot reported
- Risk of bias assessedNot reported
- Bias considered in synthesisNot reported
- Publication bias assessedNot reported
- Study exclusions justifiedNot reported
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.The primary outcome (POD1 pain) showed many statistically significant pairwise differences that were then judged clinically insignificant using an externally sourced MCID of 1.86; how robust is that threshold, and could it be masking real differences in some subgroups?
2.If no block meaningfully reduces day-1 pain, should a surgeon still choose PENG or intrathecal morphine purely for their opioid-sparing and length-of-stay benefits, and what does that mean for patients who cannot receive intrathecal morphine (e.g., outpatient/no spinal anaesthesia)?
Original publication title
Comparative efficacy of analgesic techniques in total hip arthroplasty