The PROSPECT working group has recently published an updated systematic review and procedure-specific pain management recommendations for hip arthroplasty [1]. While we are grateful for the update of the 2010 guidelines, we think some analgesic options recommended must be interpreted with caution. Furthermore, we think that promising regional anaesthesia techniques merit further discussion.

Among the seven main recommendations, the review recommends considering intrathecal morphine if the patient receives spinal anaesthesia for surgery, despite significant disagreement among authors regarding intrathecal morphine. Even if its analgesic effect is well-documented, intrathecal morphine is associated with significant adverse effects such as nausea, vomiting, pruritus, delayed ambulation and, rarely, respiratory depression. Therefore, we do not think that intrathecal morphine is compatible with present-day early rehabilitation protocols of orthopaedic surgery, as recommended by many anaesthesia and surgical societies [2]. Moreover, intrathecal morphine is incompatible with same-day surgery protocols, as it requires monitoring for 24 h [3] and may prevent ambulation in the first few hours after surgery.

We also believe that promising new regional anaesthesia techniques, such as the pericapsular nerve group (PENG) block, merit attention. The PENG block, first described in 2018 [4], targets sensory branches of the femoral, obturator and accessory obturator nerves, which innervate the anterior capsule of the hip joint. Since then, more than 50 articles have been published. Although most of the available literature has evaluated its use for hip fracture [5], a few publications have also assessed its potential benefits for hip replacement surgery. Although we do not yet have enough data to make a firm recommendation, we think that the PENG block deserved discussion in this systematic review and further randomised controlled trials, such as the one we are conducting (NCT04245280), are needed to evaluate its benefit after hip arthroplasty.

PROSPECT 工作组最近发布了更新的髋关节置换术系统评价和特定手术疼痛管理建议 [ 1 ]。虽然我们对 2010 年指南的更新表示感谢，但我们认为必须谨慎解释一些推荐的镇痛方案。此外，我们认为有前景的区域麻醉技术值得进一步讨论。

在七项主要建议中，该评价建议如果患者接受脊髓麻醉进行手术，则考虑鞘内注射吗啡，尽管作者对鞘内注射吗啡存在重大分歧。即使它的镇痛作用已得到充分证明，鞘内注射吗啡也会引起严重的副作用，如恶心、呕吐、瘙痒、步行延迟，以及罕见的呼吸抑制。因此，我们认为鞘内注射吗啡不符合当今许多麻醉和外科学会推荐的骨科手术早期康复方案 [ 2 ]。此外，鞘内注射吗啡与当天手术方案不兼容，因为它需要 24 小时监测 [ 3] 并且可能会在手术后的最初几个小时内阻止行走。

我们还认为，有前景的新区域麻醉技术，例如囊周神经组 (PENG) 阻滞，值得关注。PENG 阻滞于 2018 年首次描述 [ 4 ]，针对支配髋关节前囊的股骨神经、闭孔神经和副闭孔神经的感觉分支。从那时起，已经发表了50多篇文章。尽管大多数现有文献都评估了其在髋部骨折中的应用 [ 5]，一些出版物也评估了它对髋关节置换手术的潜在益处。虽然我们还没有足够的数据来做出坚定的推荐，但我们认为 PENG 阻滞值得在本系统评价中进行讨论，并且需要进一步的随机对照试验，例如我们正在进行的试验 (NCT04245280)，以评估其益处。髋关节置换术。