JBJS - 2026-05-13 - Journal Article
Glucocorticoid-Enhanced Fascial Plane and Peripheral Nerve Blocks Versus Periarticular and Local Infiltration Analgesia in Total Hip Arthroplasty: A Prospective Randomized Controlled Trial.
Li J, Rubin LE, Krishnan R, Blessing M, Townsend D, Tung WS, Zhao X, Treggiari M, He Z, Dai F, Lin HM, Leslie MP, the Yale GENBA-THA study group
Topics
Key Takeaway
Anterior quadratus lumborum block plus lateral femoral cutaneous nerve block provided no reduction in POD 1 opioid consumption (median 29.84 vs 30.50 oMME, p=0.57) compared to periarticular infiltration analgesia when both techniques incorporated dual glucocorticoids in THA.
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Summary
This RCT compared aQLB+LFCNB versus PALIA in primary THA, with both arms receiving identical dual glucocorticoid augmentation (10mg DEX + 80mg MPA) in 60mL 0.2% ropivacaine. The primary outcome—POD 1 oral morphine milligram equivalents—was equivalent between groups (29.84 vs 30.50 oMME, p=0.57). The only significant difference was lower POD 1 fasting glucose in the nerve block group (141.5 vs 153.0 mg/dL, p=0.003), with no differences in pain scores, functional recovery, or any other secondary outcome through 1 year.
Key Limitation
The study was conducted at a single center with a demographically homogeneous cohort (96% non-Hispanic, 82% White), limiting generalizability to diverse patient populations and other practice settings.
Original Abstract
BACKGROUND
The purpose of this study was to compare an anterior quadratus lumborum block (aQLB) plus a lateral femoral cutaneous nerve block (LFCNB) with periarticular and local infiltration analgesia (PALIA) in total hip arthroplasty (THA), with both modalities using dual glucocorticoids: hydrophilic dexamethasone sodium phosphate (DEX) and lipophilic methylprednisolone acetate (MPA).
METHODS
A total of 192 patients were randomized to either PALIA or aQLB+LFCNB and received 60 mL of 0.2% ropivacaine, 10 mg of DEX, and 80 mg of MPA. The mean age of the 188 included patients was 61 years, 46% were male, 96% were non-Hispanic, and 82% were White. The primary outcome was opioid consumption, measured as oral morphine milligram equivalents (oMME), on postoperative day (POD) 1. Secondary outcomes included opioid consumption on POD 2, fasting serum glucose, white blood-cell count, Brief Pain Inventory (BPI) pain severity and interference, and functional recovery measures, including Activity Measure for Post-Acute Care (AMPAC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, from POD 0 to 1 year.
RESULTS
Ninety-three patients in the aQLB+LFCNB group and 95 patients in the PALIA group were included in the final analysis. There was no significant difference in the primary outcome, oMME on POD 1, between the aQLB+LFCNB group (median, 29.84 [interquartile range (IQR): 17.72, 38.75]) and the PALIA group (median, 30.50 [IQR: 18.00, 42.00]) (p = 0.57). Except for fasting serum glucose on POD 1, which was lower in the aQLB+LFCNB group (median, 141.50 [IQR: 124.50, 163.50] mg/dL) than in the PALIA group (median, 153.00 [IQR 139.00, 180.00] mg/dL) (p = 0.003), no significant differences were observed in any of the other secondary outcomes.
CONCLUSIONS
Patients who received aQLB+LFCNB with dual glucocorticoids and those who received PALIA with dual glucocorticoids demonstrated no significant differences in daily opioid consumption, pain score, or functional recovery following THA.
LEVEL OF EVIDENCE
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.