Perioperative Medicine
The Future of Anesthesiology
Hip Replacement/Fracture
Anger, M., Valovska, T., Beloeil, H., Lirk, P., Joshi, G.P., Van de Velde, M., Raeder, J. and (2021), PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. https://doi.org/10.1111/anae.15498
Bottom line:
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The PROSPECT guideline for total hip arthroplasty is a systematic review that developed recommendations for the management of postoperative pain after primary elective total hip arthroplasty. Perioperative interventions that improved postoperative pain include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), cyclo-oxygenase-2 (COX-2) selective inhibitors, IV dexamethasone, peripheral nerve blocks (fascia iliaca block; femoral nerve block; lumbar plexus block), single-shot infiltration analgesia, epidural analgesia, and intrathecal morphine improved pain.
Major points:
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1. Preoperative exercise and education are recommended
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2. The basic analgesic regime should include a combination of acetaminophen and an NSAID or COX-2 selective inhibitor administered pre-operatively or intra-operatively and continued postoperatively
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3. A single dose of IV dexamethasone 8-10 mg is recommended
4.A single-shot fascia iliaca block or local infiltration is recommended
5. Consider 0.1 mg intrathecal morphine if the patient receives spinal anesthesia
6. Opioids should be reserved as rescue analgesics in the perioperative period
7. Avoid femoral nerve and lumbar plexus blocks as well as epidural analgesia due to the significant incidence of muscle weakness and delayed mobilization
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