Supplemental
Table 1.
Characteristics
of additional
randomized
controlled trials
included in the
network metaanalysis
Study
Patients
Groups
(number)
Procedure
Intervention
Components
Anesthesia/oral
analgesia
Comparison
Administration
Components
methods
Local infiltration analgesia vs epidural analgesia
Postoperative
analgesic
protocol*
Rescue analgesia*
Administration methods
Pandazi et al.
[7]
2013
Greece
Total: 41
Age, mean: not
available†
Sex, F%: not
available†
Diagnosis: OA
BMI: not
available†
ASA class, not
available†
1. LIA (20)
2. Epidural
analgesia,
continuous
infusion (21)
Elective
unilateral THA
posterolateral
approach,
cementless,
drainage
Ropivacaine 3 mg/kg,
morphine 4-10 mg
(titration)
methylprednisolone 40
mg
epinephrine 1/1000
(0.3 mL-300 mcg)
clonidine 1 mcg/kg
cefuroxime 750 mg
diluted in NS to 100
mL.
Single-shot
intraoperative
LIA,
intraarticular
injection
Ropivacaine 0.2%
(2 mg/mL),
commenced at a
rate of 4 mL/hour
and titrated to
maintain sensory
blockade of the
surgical site.
Continuous
infusion
postoperative,
combined
spinal-epidural
technique
Spinal
Standardized
anesthesia and
oral (pre- and
postoperative)
analgesic
protocol.
8 mg IV q 12
hours,
paracetamol
500 mg q 6
hours
PCA
morphine IV: 1 mg/mL,
dose: 0.8-1.2 mL, according
to patient’s age,
lockout interval: 8 minutes
Andersen et al.
[1]
2007
Denmark
Total: 75
Age, mean: 61.5
years
Sex, F%: 53.3%
Diagnosis: OA
BMI: 26.5 kg/m2
ASA Classes IIII
1. LIA (38)
2. Epidural
analgesia,
continuous
infusion (37)
Elective
unilateral THA
posterior
approach,
cementless (43),
cemented (24),
and hybrid (8)**
prosthesis.
Drainage
Intraoperative
ropivacaine 2 mg/mL;
100 mL,
ketorolac 30 mg/mL; 1
mL,
epinephrine 1 mg/mL;
1 mL
Double-shot
intraoperative
and
postoperative (8
hours after
surgery, by
catheter),
intraarticular
and
subcutaneous
injection
Ropivacaine 0.2%
(2 mg/mL),
morphine 5
µg/mL
started at a rate of
4 mL/hour and
was titrated to
maintain sensory
blockade of the
surgical site.
Continuous
infusion
postoperative,
combined
spinal-epidural
technique
Spinal
Standardized
anesthesia and
oral (pre- and
postoperative)
analgesic
protocol.
Paracetamol
1 g by mouth
q 6 hours
Oxycodone 5-10 mg by
mouth (if VAS > 30 mm).
nicomorphine 5-10 mg IV
if pain persisted.
No restrictions regarding
frequency of drug administration
or the overall daily dose.
postoperative
ropivacaine 7.5
mg/mL; 20 mL
ketorolac 30 mg/mL; 1
mL;
epinephrine 1 mg/mL;
0.5 mL
Local infiltration analgesia vs intrathecal morphine
Kuchálik et al.
[6]
2013
Sweden
Total: 78
Age, mean: 66.5
years
Sex, F%: 43.6%
Diagnosis: not
available
BMI: 28.9 kg/m2
ASAClasses I-II
1. LIA (39)
2. Intrathecal
morphine
(39)
Elective
unilateral THA
Intraoperative
ropivacaine 2 mg/mL;
150 mL
ketorolac 30 mg/mL; 1
mL
epinephrine 1 mg; 0.5
mL
Postoperative†
ropivacaine 7.5
mg/mL; 20 mL
ketorolac 30 mg/mL; 1
mL
epinephrine 1 mg; 1
mL
Rikalainen et al.
[8]
2012
Finland
Total: 57
Age, mean: 65.5
years
Sex, F%: 64.9%
Diagnosis: OA
BMI: 26 kg/m2
ASA Classes IIII
1. LIA (29)
2. Intrathecal
morphine
(28)
Primary
unilateral THA,
transgluteal
Hardinge
approach,
cemented
prosthesis
Intraoperative
levobupivacaine 1.25
mg/mL; 100 mL
ketorolac 30 mg/mL 1
mL,
epinephrine 0.1
mg/mL; 0.5 mL
Postoperative (1)
levobupivacaine 1.25
mg/mL; 10 mL
Postoperative (2)
levobupivacaine 5
mg/mL; 20 mL
ketorolac 30 mg/mL;
1mL
Double-shot
intraoperative
and
postoperative
(24 hours after
surgery by
catheter),
intraarticular
and
subcutaneous
injection
Morphine
(preservativefree) 0.1 mg (0.25
mL)
Injected
intrathecally
with spinal
anesthesia.
Spinal
Standardized
anesthesia and
oral (pre- and
postoperative)
analgesic
protocol.
Paracetamol
1 g by mouth
every 6 hours
PCA
Morphine IV: 1 mg/mL,
lockout interval: 6 minutes
maximum 10 mg/hour
(when NRS > 3).
Triple-shot
intraoperative
and
postoperative
(1) after
insertion of
prosthesis and
before closure
of fascia; (2) on
the morning of
the 1st
postoperative
day by catheter.
Intraarticular
and
subcutaneous
injection
Morphine
(preservativefree) 0.1 mg (2
mg/mL)
Injected
intrathecally
with spinal
anesthesia.
Spinal
Standardized
anesthesia and
oral (pre- and
postoperative)
analgesic
protocol.
Paracetamol
1g by mouth
every 8
hours,
ibuprofen
400
mg every 12
hours
PCA
Oxycodone IV: 2 mg/mL,
dose 2 mg, lockout time
10 minutes (if rescue
oxycodone [3 mg IV or
5-10 mg by mouth] was
needed more than 3 times
in 2 hours)
Not available
Ketorolac 30
mg,
maximum 90
mg/24 hours
(by patient
demands)
PCA
Morphine IV: 2 mg bolus,
with 10 minutes lockout
and 1 hour limit of 8 mg.
Peripheral nerve blocks vs epidural analgesia
Dauri et al. [3]
2011
Italy
Total: 57
Age, mean: 67.4
years
Sex, F%: 50.7%
Diagnosis: not
available
BMI: 27.5 kg/m2
ASA Classes IIII
1. CLPB (22)
2. CLPSB
(23)
3. Epidural
analgesia,
continuous
infusion. (24)
Unilateral THA
CLPB
Ropivacaine 3 mg/kg
(maximum 200 mg),
clonidine 1 µg/mL
CLPSB
After performing
CLPB ropivacaine 5
mg/mL; 20 mL and
clonidine 15 µg to the
sciatic nerve.
Continuous infusion:
ropivacaine 2 mg/mL
at 8 mL/hour.
Continuous
infusion
Preoperative
Neurolocation:
Nerve stimulator
CLPB was
performed as
described by
Capdevila et al.
[2];
CLPSB was
performed by
using Mansours'
landmarks.
Ropivacaine 1
mg/kg (maximum
100 mg)
Continuous
infusion of
ropivacaine 2
mg/mL at 8
mL/hours.
Continuous
infusion
postoperative
Combined
spinal-epidural
technique.
Sensory level of
the block was
assessed by loss
of pinprick
sensation.
Duarte
et al. [4]
2009
Brazil
Singelyn et al.
[9]
2005
Belgium
Turker et al.
[11]
2003
Turkey
Total: 41
Age, mean: 57.8
years
Sex, F%: 29.3%
Diagnosis: OA,
ONFH, RA, AS.
BMI: 27.3 kg/m2
ASA Classes IIII
Unilateral
THA
Lateral or
posterior
approach
(patients
were
stratified
according to
surgical
approach)
1. CLPB (20)
2. Epidural
analgesia,
continuous
infusion (21)
Total: 30
Age, mean: 64
years
Sex, F%: 60%
Diagnosis: not
available
BMI: 27.3 kg/m2
ASA Classes IIII
Elective
unilateral
THA
1. CFNB (15)
2. Epidural
analgesia,
continuous
infusion (15)
Total: 30
Age, mean: 62.3
years
Sex, F%: 43.3%
Diagnosis: not
available
BMI: 26.3 kg/m2
ASA Classes IIII
Partial hip
replacement
1. CPCB (15)
2. Epidural
analgesia,
continuous
infusion (15)
Ropivacaine 0.5% 0.4
mL/kg
Continuous infusion of
ropivacaine 0.2% at
0.0625 mL/kg, patientapplied dose of 0.0625
mL/kg, and blockade
interval of 30 minutes
Bupivacaine 0.25%,
epinephrine 1:200,000;
total volume: 40 mL
Continuous infusion of
bupivacaine 0.125% at
a rate of 10 mL/hour.
Bupivacaine 0.5%; 30
mL.
Continuous infusion
bupivacaine 0.125%
and fentanyl 2 µg/mL
at 10 mL/hour, in
addition to 5 mL
boluses. Blockade time
of 30 minutes and 4
hours maximum
Continuous
infusion
preoperative
Neurolocation:
Nerve stimulator
LPB was
performed
according to the
technique
described by
Capdevila et al.
[2]
Continuous
infusion
preoperative.
Neurolocation:
Nerve stimulator
The block was
performed
following the
landmarks of
Winnie et al.
[12]
Single-shot
preoperative
Neurolocation:
Nerve stimulator
Contrast
solution was
injected to
verify correct
catheter
positioning.
Ropivacaine
0.5%; 10-15 mL
(according to the
height of the
patients)
Continuous
infusion of
ropivacaine 0.2%
(with fentanyl) 3
mg/mL at 0.0625
mL/kg, patientapplied dose of
0.0625 mL/kg,
and blockade
interval of 30
minutes.
Bupivacaine
0.25%,
epinephrine
1:200,000
sufentanil 10 µg;
total volume 10
mL.
Continuous
infusion of
bupivacaine
0.125% at a rate
of 10 mL/hour.
Bupivacaine
0.5%; 15 mL
Continuous
infusion
of bupivacaine
0.125% and
fentanyl 2 µg/mL
at 10 mL/hour, in
addition to 5 mL
boluses. Blockade
Continuous
infusion
preoperative
Standardized
oral (pre- and
postoperative)
analgesic
protocol.
No other
analgesic or
antiinflammatories.
Morphine IV 50 µg/kg
(requested by patient)
Continuous
infusion
preoperative
(before
induction of
general
anesthesia)
General
Standardized
anesthesia and
oral (pre- and
postoperative)
analgesic
protocol.
Propacetamol
1g IV if VAS
≥ 3.
Piritramide
10 mg IM if
VAS
remained
unchanged
after 30
minutes.
PCA
Morphine IV:
1.5 mg bolus,
lockout of 8
minutes
Preoperative
(before
induction of
general
anesthesia)
General
Standardized
anesthesia and
oral (pre- and
postoperative)
analgesic
protocol.
Diclofenac
IM 75 mg if
pain relief
was
inadequate.
PCA - see
continuous infusion of
blocks.
PCA - see continuous
infusion of blocks.
volume of 60 mL.
time of 30
minutes and 4
hours maximum
volume of 60 mL.
Peripheral nerve blocks vs intrathecal morphine
Frassanito et al.
[5]
2008
Italy
Total: 40
Age, mean: 70
years
Sex, F%: 55%
Diagnosis: not
available
BMI: 26.7 kg/m2
ASA Classes IIII
Primary
unilateral
THA,
lateral
approach,
cemented
prosthesis
1. PCB (20)
2. Intrathecal
morphine (20)
Ropivacaine 0.5% 0.4
mL/kg
Single-shot
Preoperative
Neurolocation:
Nerve stimulator
performed
according to the
landmarks
described by
Capdevila et al.
[2]
Morphine 100
mcg,
bupivacaine 15
mg,
fentanyl 15 mcg
Preoperative
(before
induction of
general
anesthesia)
General
Standardized
anesthesia and
oral (pre- and
postoperative)
analgesic
protocol.
Paracetamol
1g IV every
6 hours,
ketorolac 30
mg IV every
8 hours
Tramadol 100 mg
IV if VAS > 40
mm.
Souron et al.
[10]
2003
France
Total: 53
Age, mean: 67.2
years
Sex, F%: 60.4%
Diagnosis: OA
BMI: 28.6 kg/m2
ASA Classes I-II
Primary
unilateral
THA,
posterior
approach,
cemented
prosthesis
1. PCB (26)
2. Intrathecal
morphine (27)
Ropivacaine 0.475%;
25 mL
Single-shot
Preoperative
Neurolocation:
Nerve stimulator
performed
according to the
landmarks
described by
Winnie et al.
[12]
Morphine 0.1 mg
Preoperative
(before
induction of
general
anesthesia)
General
Standardized
anesthesia and
oral (pre and
postoperative)
analgesic
protocol.
Propacetamol
2 g IV every
6 hours,
ketoprofen
100 mg IV
every 12
hours
Morphine IV (3 mg or 2
mg if patient
was older than 70 years)
every 5 minutes in the
postanesthesia unit and
subcutaneous (10 mg or
5 mg if patient is older
than 70 years) every
6 hours (maximum every
4 hours) on the ward.
*For the first postoperative day; **analysis revealed no significant differences in the distribution of patients in the surgical approach; †second shot was performed after study period for this network meta-analysis (24
hours postoperative); NS = normal saline; ASA = American Society of Anesthesiologists; PCA = patient controlled anesthesia; PCB = psoas compartment block; CPCB = continuous psoas compartment block; CLPB
= continuous lumbar plexus block; CLPSB = continuous lumbar plexus block associated with parasacral sciatic nerve block; OA = osteoarthritis; ONFH = osteonecrosis of femoral head; RA = rheumatoid arthritis;
AS = ankylosing spondylitis; NRS = numerical rating scale; IM = intramuscular; IV = intravenous.
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