Pain control following total hip arthroplasty: a prospective randomized controlled trial comparing spinal anaesthesia without adjuncts versus fascia iliaca block versus pericapsular nerve group block versus local anaesthetic infiltration

Listen to Brian and Lisa discuss the paper 'Pain control following total hip arthroplasty: a prospective randomized controlled trial comparing spinal anaesthesia without adjuncts versus fascia iliaca block versus pericapsular nerve group block versus local anaesthetic infiltration' published in the May 2026 issue of Bone & Joint Open.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today, we're discussing the paper, 'Pain control following total hip arthroplasty: a prospective randomized controlled trial comparing spinal anaesthesia without adjuncts versus fascia iliaca block versus pericapsular nerve group block versus local anaesthetic infiltration', published in May 2026 by JP Park and colleagues.

I'm Brian, and I'm joined by my co-host, Lisa.

Hello, everyone. Brian, this study addresses an essential part of postoperative care, pain management after total hip arthroplasty, or THA. It's a hot topic as effective pain control can greatly affect the patient's recovery and overall satisfaction. Indeed. The primary aim of this study was to compare different strategies for managing postoperative pain.

They examined spinal anesthesia alone against three various adjuncts: fascia iliaca [00:01:00] block, FIB; pericapsular nerve group, PENG block; and local anesthetic infiltration, LAI. Could you walk us through their methods, Lisa?

This was a single-centre, assessor- and participant-blinded randomized controlled trial involving 240 patients. These patients were randomly assigned to one of four groups: spinal anesthesia alone, LAI, FIB, or PENG block. Pain was measured using the visual analog scale at different intervals, including four hours postoperatively, which was their primary outcome. And what did they discover?

At four hours postoperatively, LAI was found to significantly reduce pain compared to the control group with a mean visual analog scale of 1.6 compared to 3.0 in the control group. Interestingly, neither FIB nor PENG block showed a significant reduction in early [00:02:00] postoperative pain.

That’s quite a difference. Were there any variations in opioid consumption? Both FIB and LAI significantly reduced opioid consumption in the first 24 and 48 hours postoperatively compared to the control group.

Specifically, LAI showed a marked reduction in opioid use at both 24 hours, 22.2 milligrams morphine equivalent versus 36.7 milligrams morphine equivalent in the control, and 48 hours, 39.0 milligrams morphine equivalent versus 60.0 milligrams morphine equivalent in the control.

It appears LAI not only alleviated pain effectively but also decreased reliance on opioids, which is a significant benefit given the ongoing opioid crisis. Absolutely. Additionally, LAI was linked to higher patient satisfaction at four hours postoperatively and on postoperative day two. Patient satisfaction scores for [00:03:00] LAI were markedly better, suggesting that patients were quite content with their pain management.

Regarding satisfaction, how did the other methods compare? FIB also showed improved patient satisfaction on postoperative day two, but not as significantly as LAI. PENG block, however, seemed to provide outcomes similar to spinal anesthesia alone, indicating limited utility in this specific context. That’s quite enlightening.

To summarize, it seems LAI stands out as the superior method for early postoperative pain control in THA, especially considering reduced pain, lower opioid consumption, and higher patient satisfaction. Precisely, Brian. This study marks a milestone as it clarifies which adjuncts are most effective, potentially guiding future clinical practices to improve patient care in THA.

That’s all we have time for today on AI Talks with Bone & Joint. Thank you for listening, everyone.