2025/09/02 by Longsheng Zhang, Zitian Luo, Renzhe Lin · 1 voice
Medicine · #Anesthesia and Pain Management #Spine and Intervertebral Disc Pathology #Cardiac, Anesthesia and Surgical Outcomes
paper · pdf · doi:10.1111/anae.16767
openalex publication_date 2025/09/02 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/16
We congratulate Buffoli et al. on the comparison of the combination of pericapsular nerve group (PENG) and lateral femoral cutaneous nerve blocks with erector spinae plane (ESP) block for analgesia after primary elective total hip arthroplasty [1]. We suggest two points for future clinical research. First, the temporal match between block duration and the early mobilisation window warrants closer scrutiny. Sensory block from single-shot ropivacaine 0.5% regresses typically within 8–12 h, yet patients are encouraged to ambulate 6–10 h after surgery. A potential analgesic gap between 12 h and 24 h could obscure any real difference between the two techniques. Future trials could incorporate dexamethasone as an adjuvant or employ liposomal bupivacaine to prolong analgesia [2], while objective gait analysis with accelerometers would provide a more sensitive assessment of motor power. Second, the influence of obesity and skeletal morphometry on block success deserves more detailed evaluation. The reported mean BMI was 26–27 kg.m-2, effectively excluding patients with severe obesity in whom an enlarged iliopsoas fat pad and deeper osseous landmarks reduce sonographic clarity. Similarly, hypertrophic lumbar transverse processes or advanced spondylosis may limit cranio-caudal spread after ESP block [3]. Stratifying by BMI and pre-procedural ultrasound measurement of iliopsoas thickness and transverse process depth would clarify the generalisability of each technique. Looking forward, we advocate the creation of a prospective registry dedicated to regional anaesthesia in joint arthroplasty, capturing real-time metrics such as block success rates, falls, duration of stay and 30-day readmission. Integration of an electronic health record-based decision support tool would allow anaesthetists, orthopaedic surgeons and rehabilitation specialists to select between PENG and ESP techniques according to BMI, lumbar morphology and surgical approach. Regulatory bodies should consider incorporating ‘zero motor block’ as a quality indicator and support standardised ultrasound-guided training to reduce operator-dependent variability. Once again, we commend Buffoli et al. for this important contribution and hope that these perspectives will stimulate further refinement of precision, safety and patient-centred peri-operative analgesia.