Comparative efficacy of analgesic techniques in total hip arthroplasty : a systematic review and network meta-analysis of more than 100 randomized studies incorporating minimal clinically important difference.

Abstract

We compared the analgesic efficacy of commonly used analgesic techniques in patients undergoing total hip arthroplasty (THA). This included femoral nerve block, supra- and infrainguinal fascia iliaca block, lumbar plexus block (LPB), intrathecal morphine (ITM), periarticular injection (PAI), pericapsular nerve group block (PENG), iliopsoas block (IPB), anterior, lateral, and posterior quadratus lumborum block (QLA/QLL/QLP), lateral femoral cutaneous nerve block (LFCNB), and placebo. A systematic search of PubMed, Embase, The Cochrane Library, and Web of Science from their date of inception through to December 2025 was performed. The primary outcome of interest was postoperative day 1 (POD1) pain scores. Secondary outcomes of interest include pain levels at 12 hours postoperatively, opioid consumption within 24 hours after surgery, time to first mobilization, and hospital length of stay. Clinical and statistical significance were evaluated for each outcome. We identified 112 studies. No analgesic technique demonstrated a clinically meaningful reduction in POD1 pain scores. IPB + PAI showed clinically meaningful reduction in 12-hour pain scores when compared with placebo. Similarly, both ITM and IPB + PAI showed clinically meaningful reduction in opioid consumption. Statistically significant reduction in time to first mobilization was seen in the PENG + LFCNB, QLL, PENG, and suprainguinal fascia iliaca block groups as compared with placebo. The hospital length of stay was shorter in the ITM and PENG groups as compared with placebo. Within the limitations of this study, clinically meaningful reduction in pain scores was not observed in most analgesic techniques following THA. ITM demonstrated reduction in 24-hour opioid consumption with a shorter length of hospital stay, while PENG demonstrated shorter time to mobilization as well as a shorter length of hospital stay. Interpretation of these results should consider the substantial heterogeneity encountered in the measurement of 24-hour morphine consumption, as well as the potential side effects of ITM.