Advantages and issues of concern regarding approaches to peripheral nerve block for total hip arthroplasty

Table 1 General features of the enhanced recovery after surgery pathway for hip fracture repair surgery, modified from Wainwright et al[7]

Preoperative	Preoperative multimodal analgesia should include regional anesthesia (e.g., femoral nerve block, fascia iliac block) and minimization of opioids use.
	Maintain preoperative hydration. The routine administration of sedatives to reduce anxiety is not recommended.
	Avoid prolonged preoperative fasting and recognize gastric motility may be altered in patients with hip fractures.
Intraoperative	Minimize PONV by using anesthetic techniques that reduce it (i.e., NA or TIVA), and drug prophylaxis.
	Avoid anticholinergic and antihistamine as antiemetics in older patients, due to increased risk of confusion or agitation.
	Individualize fluid management.
	Use of tranexamic acid for reduced blood loss.
	Optimize glycemic control.
	Maintain normothermia.
Postoperative	Use multimodal opioid sparing analgesic strategy including local infiltration analgesia, nonopioid analgesics (e.g., acetaminophen and/or NSAIDs), and possibly tramadol.
	Avoid any sedatives and respiratory depressants.
	Fast mobilization/rehabilitation.

PONV: Postoperative nausea and vomiting; NA: Neuraxial anesthesia; TIVA: Total intravenous anesthesia; NSAIDs: Nonsteroidal anti-inflammatory drugs.