Postoperative pain management after total hip arthroplasty: The updated guideline from PROSPECT

The PROSPECT initiative, led by an expert working group of anaesthesiologists and surgeons, provides healthcare professionals with practical recommendations for postoperative pain management in common surgical procedures.

Total hip arthroplasty (THA) is frequently performed and associated with significant postoperative pain. Patients require effective analgesia with minimal side effects to enable early postoperative mobility and functional recovery (Joshi 2019). However, there is wide variability in the peri-operative anaesthetic and analgesic regimens used.

Clinicians have needed an up-to-date guideline providing an evidence-based approach to pain management for elective THA. The PROSPECT working group has delivered with this recent publication, which was widely shared on social media (attention score in the top 5% of all research outputs on Altmetric):

“PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations” (Anger M, et al. Anaesthesia 2021; 76: 1082–1097).

The guideline was developed based on a systematic literature review that focused on postoperative pain outcomes. Using PROSPECT’s unique approach, the working group assessed the effects of analgesic interventions in reference to the use of basic analgesics (paracetamol and NSAIDs or COX-2 selective inhibitors) and the balance of risks and benefits in the context of multimodal, non-opioid analgesic strategies and modern peri-operative care pathways.

The overall recommendations for elective THA are shown in Table 1 and are also available on the PROSPECT website.

The evidence, recommendations and methodology for THA and all the PROSPECT reviews (currently 19 surgical procedures) can be found on the website, esraeurope.org/prospect, together with links to all PROSPECT publications (most are open access).

New PROSPECT reviews and updates are underway. Those nearly finalised include sternotomy, hip fracture, total knee arthroplasty (update), video-assisted thoracoscopic surgery, laparoscopic colectomy, open abdominal hysterectomy and prostatectomy.

PROSPECT is supported by an unrestricted grant from the European Society of Regional Anaesthesia and Pain Therapy (ESRA) as an independent Working Group of the society.