For hip replacement analgesia, a fascial plane block did no better than periarticular infiltration

The edition in brief

In a randomised trial of 188 patients having total hip arthroplasty (JBJS, May 2026), anterior quadratus lumborum plus lateral femoral cutaneous nerve block gave the same day-1 opioid use as periarticular and local infiltration when both carried dexamethasone and methylprednisolone (median 29.8 vs 30.5 mg oral morphine equivalent; p = 0.57), with no difference in pain or function to one year. A 791-shoulder cohort found anatomic total shoulder arthroplasty survival of 96.1% at 10 and 93.7% at 15 years; 69.5% of shoulders reached an acceptable symptom state at 10 years, and younger age and Walch B glenoids predicted revision. A 17-country registry model projects revision hip and knee volumes rising 31% and 41% by 2060. In 42,338 UK infants, a documented clicky hip was associated with treated hip dysplasia (adjusted OR 4.68; 1 in 28 had it). Intravenous lidocaine did not significantly reduce rebound pain after interscalene block in an underpowered trial. Pearl: give oral analgesia before the block wears off.