2025/09/02 by Ci‐En Li, Qian‐Qian Guo · 1 voice
Medicine · #Anesthesia and Pain Management #Spine and Intervertebral Disc Pathology #Cardiac, Anesthesia and Surgical Outcomes
paper · pdf · doi:10.1111/anae.16764
openalex publication_date 2025/09/02 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/16
The rigorous methodology and clinically relevant findings of Buffoli et al. advance our understanding of motor-sparing regional anaesthesia techniques significantly and provide compelling evidence that both pericapsular/lateral femoral cutaneous nerve and erector spinae blocks are effective multimodal analgesia options for total hip arthroplasty [1]. However, we wish to highlight several issues. The focus of the study on posterolateral total hip arthroplasty under spinal anaesthesia ensures internal validity but may limit applicability to other approaches (e.g. direct anterior or lateral) or general anaesthesia. Given the anatomical and nociceptive differences across surgical approaches, could the authors comment on whether block efficacy might vary in these scenarios? Additionally, the exclusion of patients with chronic pain or opioid tolerance merits discussion as this is a population at high risk of poorly controlled postoperative pain [2] and their inclusion could clarify the efficacy of the block in this group. While 24-h morphine consumption is a pragmatic endpoint, the low median requirement in both groups (5 mg) raises questions about the clinical significance of the observed equivalence. Incorporating patient-centred outcomes (e.g. quality of recovery and time to ambulation or patient satisfaction) might better capture meaningful differences between techniques [3]. Furthermore, the use of ropivacaine 0.5%, though standardised, may have contributed to the motor block observed in the erector spinae plane group (5/31 patients). Would lower concentrations (e.g. 0.2%) have preserved analgesia while reducing motor impairment? The absence of chronic pain differences at 3 months is reassuring, but the attrition-adjusted sample (n = 47) may be underpowered. Subgroup stratification by pre-existing pain or frailty could elucidate whether certain populations derive differential benefits. Additionally, cost-effectiveness data (e.g. block performance time and equipment costs) would aid clinical decision-making, particularly in resource-limited settings. While the findings underscore the importance of individualising block selection based on patient and surgical factors, addressing the above considerations could further refine the role of these techniques in enhanced recovery protocols.