No effect of double nerve block of the lateral cutaneous nerve and subcostal nerves in total hip arthroplasty

Figures & data

Table 1. Overview of the trials with LIA performed in THA patients. Note the remarkable variation in the LIA suspension, localization of infiltration, surgical approach, and endpoint studied

Study	N	Set up	Control	Approach ^a	Suspension ^b	Infiltration ^c	Results
Bianconi et al. 2003	?	RCT	NaCl	PL	R	SC	Lower VAS first 72h
Andersen et al. 2007a/b	80	RCT	epidural	PL	R/K/A	WI + IA	2 days earlier discharge
Andersen et al. 2007a/b	40	RCT	NaCl	PL	R/K/A	WI	Less pain 2 weeks, better function after 1 week
Busch et al. 2010	64	RCT	–	SL	R/K/A	C + SC	Less pain/medication use first 24 h
Lunn et al. 2011	120	RCT	NaCl	PL	R/A	C + M + SC	No differences in pain score
Andersen et al. 2011	12 ^d	RCT	NaCl	PL	R/A	WI	No differences in pain score and length of stay
Banerjee&McLean 2011	204	retro	–	?	R/K/A	WI	Faster mobilisation and discharge
Murphy et al. 2012	91	RCT	NaCl	PL	bupi	C + M + SC	Les opioid consumption first 12 h
Dobie et al. 2012	96	RCT	–	PL	Bupi/A	LC + C+M + SC	No differences pain/mobilisation
Rikalaine et al. 2012	60	RCT	–	?	B/K/A	C + M + SC	No difference VAS, less urinary retention, faster mobilisation
Kuchalik et al. 2013	80	RCT	epidural	?	R/K/A	C + M + SC	Less pain during mobilisation less escape medication
Pandazi et al. 2013	63	RCT	PCA	?	R/K/A	C + M	Less pain and opioid consumption first 24h
Zoric et al. 2014	60	RCT	NaCl	PL	R	C + M + SC	No differences opioid consumption/mobilisation
den Hartog et al. 2015	75	RCT	NaCl	A	R/A	C + M + SC	No differences

^a Approach: PL = posterolateral, SL = straight lateral, A = anterior

^b Suspension: R = ropivacaine, K = ketorolac, A = adrenalin

^c Infiltration: SC = subcutaneous, WI = wound infiltration, IA = intraarticular, C = capsule, M = muscle, LC = lateral cutaneous nerve

^d bilateral

Figure 1. Flow chart of the study.

Figure 2. Pain scores of both groups decline in time postoperatively.

^a At the first time point the LIA group has a statistically significant lower pain score compared with the placebo group.

Table 2. Overview of patient demographics and baseline characteristics in both groups

	Placebo (n = 80)	Ropivacaine (n = 82)
Sex, n (%)
Male	32 (40)	36 (44)
Female	48 (60)	46 (56)
Age, mean (SD)	66 (9.4)	67 (8.7)
BMI, mean (SD)	28 (4.9)	28 (5.0)
ASA, n (%)
ASA 1	22 (28)	24 (29)
ASA 2	58 (72)	58 (71)
HOOS, mean (SD)
Symptoms	45 (16)	40 (16)
Pain	46 (17)	45 (18)
ADL	46 (16)	44 (15)
Sport/rec	25 (18)	31 (24)
QOL	30 (12)	27 (14)
OHS, mean (SD)	23 (7.4)	24 (7.6)
SF12, mean (SD)
PCS	42 (5.4)	40 (6.3)
MCS	45 (5.7)	46 (5.2)

No statistically significant differences are observed.

Table 3. Overview of results of pain scores and questionnaires in both groups. Values are mean (95% CI)

			Between group difference
	Placebo	Ropivacaine	Unadjusted	Adjusted ^a	p-value
NRS pain at rest
6 hours	4.2 (3.6–4.9)	3.3 (2.6–3.9)	0.9 (0.1 to 1.7)	0.9 (0.04 to 1.7)	0.04
12 hours	3.5 (2.9–4.0)	3.6 (2.9–4.4)	−0.1 (-1.1 to 0.8)	−0.2 (-1.1 to 0.8)	0.8
18 hours	3.6 (3.2–4.1)	3.3 (2.9–3.7)	0.3 (-0.3 to 0.9)	0.3 (-0.3 to 0.9)	0.3
24 hours	2.9 (2.4–3.3)	2.5 (2.1–2.9)	0.4 (-0.2 to 0.9)	0.4 (-0.2 to 1.0)	0.2
32 hours	2.6 (2.2–2.9)	2.2 (1.8–2.6)	0.4 (-0.1 to 0.8)	0.4 (-0.1 to 0.8)	0.2
40 hours	2.0 (1.6–2.5)	2.6 (2.0–3.2)	−0.5 (-1.3 to 0.2)	−0.6 (-1.3 to 0.2)	0.1
HOOS (at 6 weeks)	(n = 53)	(n = 57)
Symptoms	74 (70–79)	74 (70–79)	−0.2 (-6.4 to 6.1)	−0.2 (-6.0 to 6.5)	0.9
Pain	83 (79–87)	82 (78–86)	0.7 (-5.2 to 6.6)	0.5 (-5.5 to 6.5)	0.9
ADL	77 (73–82)	78 (74–82)	−0.7 (-6.8 to 5.4)	−0.8 (-7.0 to 5.4)	0.8
Sports/Rec	55 (48–62)	58 (50–65)	−2.5 (-12.6 to 7.7)	−2.3 (-12.7 to 8.0)	0.7
QOL	57 (51–62)	61 (55–67)	−4.3 (-12.4 to 3.8)	−4.3 (-12.5 to 3.8)	0.3
OHS (at 6 weeks)	13 (11–15)	12 (10–14)	1.1 (-1.7 to3.8)	1.1 (-1.7–3.9)	0.4
SF12 (at 6 weeks)
PCS	45 (43–47)	45 (43–48)	−0.6 (-3.7 to 2.6)	−0.7 (-3.9 to 2.5)	0.7
MCS	45 (43–46)	44 (42–46)	0.6 (-2.3 to 3.5)	0.6 (-2.4 to 3.5)	0.7

^a Between-group differences adjusted for age, gender, and BMI.

Only at T = 6 hours is the pain score in the LIA group significantly lower compared with the placebo group with a p-value of 0.04. However, note that the p-value required for significance is < p = 0.008 after Holm’s procedure.

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