Historically,
general anesthesia has been the "gold standard" for surgeons and patients when major hip surgery is being done. The recent introductions of improved techniques and
catheters for continuous peripheral nerve blocks have made
regional anesthesia more attractive to patients and surgeons. We focus on current trends and future directions in perioperative
pain management for major orthopaedic procedures done on the hip. The use of epidural or
spinal anesthesia during major hip surgery has been linked to a reduced risk of perioperative complications like
deep venous thrombosis, less deterioration of cerebral and pulmonary functions in patients who are at high risk for complications, and overall reduced blood loss. In addition, continuous peripheral nerve blocks showed effective and safe
postoperative pain control, allowing for lower
opioids consumption, improved and earlier rehabilitation, and high patient satisfaction. Accurate patient selection and patient education are fundamental for the success of any
regional anesthesia technique. Modern
regional anesthesia for major hip surgery includes the use of a single shot and continuous
epidural injections, single-shot and continuous
spinal injection, continuous lumbar plexus blockade, and continuous peripheral blockade of the femoral and sciatic nerves. Continuous peripheral nerve blocks represent an adjunctive, effective, and safe technique for
postoperative pain control after
total hip arthroplasty. Future directions in
postoperative pain control include the creation of a comprehensive system that supervises the use of continuous peripheral nerve blocks outside the acute inpatient setting for few days following the
surgical procedure.
LEVEL OF EVIDENCE: Therapeutic study, Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.