Analgesic benefits of motor-sparing fascial plane blocks in comparison to periarticular local infiltration analgesia for total hip arthroplasty: A network meta-analysis

Background: Periarticular local infiltration analgesia has become an important mainstay of multimodal analgesia following elective total hip arthroplasty (THA). However, the role of novel motor-sparing fascial plane blocks – with or without periarticular local infiltration analgesia – has not been fully elucidated for patients undergoing THA. We conducted a network meta-analysis evaluating the relative analgesic effectiveness of motor-sparing fascial plane blocks (quadratus lumborum, erector spinae, and pericapsular nerve group blocks) and periarticular local infiltration analgesia for adult patients undergoing THA. Methods: Randomized trials examining single-injection quadratus lumborum, erector spinae, or pericapsular nerve group blocks, or periarticular local infiltration analgesia, for THA were sought. The primary outcome was area under the curve (AUC) rest pain scores over 0-24 hours. Secondary outcomes included rest pain scores at 0, 6, 12, and 24-hours; post-operative function at 6, 12, and 24 hours; analgesic consumption at 0-24 hours; incidence of opioid related side effects; and incidence of block related complications. Network meta-analysis was performed using a frequentist approach. Results: 44 trials (3,579 patients) evaluating the quadratus lumborum block, erector spinae block, pericapsular nerve group block, or periarticular local infiltration analgesia for THA were considered. Network meta-analysis was used to derive the probability of each intervention being the most effective as compared to the others (P-score). For AUC 0–24-hour rest pain, periarticular local infiltration analgesia was the most effective intervention as demonstrated by a P-score of 89%. For post-operative analgesic consumption, the quadratus lumborum block was the most effective intervention with a P-score of 88%, this was followed by the pericapsular nerve group block (74%), the erector spinae block (38%), and periarticular local infiltration analgesia (42%). Conclusions: Periarticular local infiltration analgesia alone provides the most consistent improvements in post-operative rest pain, analgesic consumption, and functional recovery after THA. The addition of a quadratus lumborum block or pericapsular nerve group block to periarticular local infiltration may further improve analgesic outcomes.