- Design
- Prospective randomised controlled trial
- Population
- 188 adults having primary total hip arthroplasty
- Primary outcome
- Oral morphine milligram equivalents on postoperative day 1
- Effect
- Median 29.8 (block) vs 30.5 (infiltration); p = 0.57
In a randomised trial (JBJS, May 2026), 192 patients having total hip arthroplasty were allocated to anterior quadratus lumborum block plus lateral femoral cutaneous nerve block, or to periarticular and local infiltration by the surgeon. Both groups received the same 60 mL of 0.2% ropivacaine with dexamethasone 10 mg and methylprednisolone acetate 80 mg; 188 were analysed.
Day-1 opioid use did not differ (median 29.8 vs 30.5 mg oral morphine equivalent; p = 0.57), and neither did day-2 opioid use, pain severity and interference, or functional recovery up to one year. Only fasting glucose on day 1 was modestly lower in the block group.
When both approaches carry the same glucocorticoid adjuncts, the block added no measurable benefit over surgeon-delivered infiltration. For units without a dedicated regional anaesthetist, infiltration is a reasonable default for hip replacement.
- Consider surgeon-delivered periarticular infiltration as the default analgesic technique for total hip arthroplasty.
- Reserve fascial plane blocks for patients where infiltration is unsuitable or as part of a specific protocol.
- If using glucocorticoid adjuncts, check glucose in patients with diabetes on the first postoperative day.
- Keep a multimodal regimen; neither technique works alone.
Why it matters
It removes the case for adding a separate block procedure, with its time and skill requirements, to every hip replacement.
Don't overread it
Both arms received the same dual glucocorticoids, so this does not compare techniques without those adjuncts.
The statistics, in plain English
Medians of 29.8 and 30.5 mg morphine equivalents are nearly identical, and p = 0.57 means any difference is consistent with chance.
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