Peripheral Nerve Blocks Reduce Postoperative Pain After Hip Replacement

Peripheral nerve blocks may reduce postoperative pain and increase patient satisfaction in adults undergoing elective primary hip replacement, according to the results of a systematic review published in Cochrane Database of Systematic Reviews.

To evaluate the benefits and harms of nerve blocks after elective hip replacement, a systematic review of 51 randomized controlled trials (n=2793) was performed. A total of 45 randomized controlled trials were included in the meta-analyses, which compared peripheral nerve block (n=1288) with any other pain management option (n=1203).

Based on moderate-quality evidence, peripheral nerve blocks were shown to reduce pain at rest on arrival in the postoperative care unit compared with systemic analgesia alone (standard mean difference [SMD], -1.12; 9 trials; 95% CI, -1.67 to -0.56; n=429; equivalent to a reduction of 3.2 points in pain level on a 0 to 10 scale).

Based on very-low-quality evidence, peripheral nerve blocks reduced the risk for acute confusional status (risk ratio [RR], 0.10; 95% CI, 0.02-0.54), pruritus (RR, 0.16; 95% CI, 0.04-0.70), and hospital length of stay (SMD, -0.75; 95% CI, -1.02- to -0.48) compared with systemic analgesia. Participant satisfaction increased with peripheral nerve block compared with systemic analgesia (SMD, 0.67; 95% CI, 0.45-0.89; 5 trials; n=363; low-quality evidence), but no difference in the number of participants walking on postoperative day 1 was reported.

Compared with neuraxial blocks, peripheral nerve blocks were associated with a lower risk for pruritus based on moderate-quality evidence (RR, 0.33; 95% CI, 0.19-0.58; 6 trials; n=299; moderate-quality evidence), but no difference was noted for pain at rest on arrival in the postoperative care unit, number of nerve block-related complications, acute confusional status, hospital length of stay, time to first walk, or participant satisfaction. 

Two reported adverse events associated with peripheral nerve blocks included local hematoma and delayed persistent paresis.

The study authors explained that, “[more than] 300,000 total hip replacements are performed each year in the [United States] alone,” and stated further, “Controlling pain after hip replacement improves patient comfort and satisfaction and enables patients to participate in rehabilitation more fully, leading to an earlier return home and reduced demand on resources.” Based on the study results, the authors concluded that, “peripheral nerve blocks may offer advantages,” compared with systemic analgesia.

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Reference

Guay J, Johnson RL, Kopp S. Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults. Cochrane Database Syst Rev. 2017;10:CD011608.