Do Regional Analgesia and Peripheral Blocks Still Have a Place in Joint Arthroplasty?

The efficacy of regional anesthesia and peripheral nerve blocks in the management of postoperative pain has resulted in widespread use of this approach in hip and knee arthroplasty. With extensive clinical use, however, the limitations of this approach have become apparent. These limitations include delays for the surgeon, inefficient use of the operating room, muscular weakness, and associated delays in physical therapy. Periarticular injection of anesthetic and analgesic medications appears to offer comparable benefits to nerve blocks in joint arthroplasty without these limitations. The long-acting anesthetic bupivacaine liposome injectable suspension (EXPAREL®, Pacira Pharmaceuticals, Inc), in particular, has been shown to be highly effective in managing postoperative pain and reducing opioid consumption. Consequently, a growing body of data and extensive clinical experience now support replacing nerve blocks with periarticular injections.