Lumbar Plexus Block vs Peri-Articular Local Anesthetic Infiltration in THA

Among the clinically relevant regional nerve blocks for primary THA, a single high quality randomized clinical trial compared a fascia iliaca compartment block and peri-articular local anesthetic infiltration, and a single high quality randomized clinical trial compared a lumbar plexus nerve block and peri-articular local anesthetic infiltration.[16, 17] Both randomized clinical trials demonstrated peri-articular local anesthetic infiltration is equivalent to either a fascia iliaca compartment or lumbar plexus nerve block regarding postoperative pain and opioid consumption.[16, 17] Peri-articular local anesthetic infiltration should be considered first before resorting to a regional nerve block in primary THA because the additional cost and risk associated with a regional nerve block do not offer any additional benefit compared to peri-articular local anesthetic infiltration. Therefore, we recommend the use of peri-articular local anesthetic infiltration over the routine use of regional nerve blocks following primary THA. However, if a patient‘s circumstance does warrant a regional nerve block, we recommend use of a fascia iliaca compartment block.