J Clin Anesth. 2025 Dec 26;109:112110. doi: 10.1016/j.jclinane.2025.112110. Online ahead of print.
ABSTRACT
PURPOSE: This Bayesian network meta-analysis (NMA) aimed to compare the perioperative efficacy of various ultrasound-guided regional blocks in individuals on total hip arthroplasty (THA).
METHODS: An extensive search was implemented across PubMed, Cochrane Library, Web of Science, and Embase up to December 9, 2024. Randomized controlled trials (RCTs) were selected to appraise postoperative analgesia and complications following ultrasound-guided lumbar plexus block (LPB), suprainguinal fascia iliaca block (SIFIB), pericapsular nerve group block (PENG), femoral nerve block (FNB), fascia iliaca block (FIB), quadratus lumborum block (QLB), erector spinae plane block (ESPB), periarticular injection (PAI), and saline control (CONTROL). Primary outcomes encompassed scores of movement-evoked pain (MEP) and pain at rest (PAR) within 12 and 24 h postoperatively.Secondary outcomes encompassed postoperative morphine equivalent consumption and the incidence of nausea and vomiting. Statistical analyses were carried out utilizing R 4.4.2 and Stata 18.
RESULTS: Eighteen studies (2016-2024) involving 1424 participants were included. Network analysis revealed that, for the primary outcome, The MEP scores in the PAI, PENG, and QLB groups were significantly lower within 12 and 24 h postoperatively.No significant differences were discovered in PAR scores within 12 h or 24 h postoperatively. Within the bupivacaine subgroup, the QLB group had lower consumption of morphine within 24 h postoperatively. Compared to others, the QLB group had the lowest consumption of morphine during the hospital stay.In terms of postoperative nausea and vomiting (PONV), regional blockade had a statistically substantial difference against the placebo control cohort.
CONCLUSION: No single regional block technique demonstrated superiority across all postoperative outcomes. Ultrasound-guided QLB was particularly effective in reducing morphine consumption, alleviating pain, and decreasing PONV. PAI and PENG also demonstrated efficacy in reducing postoperative pain and consumption of morphine. Future large-scale multi-center RCTs are necessary to further validate these findings.
PMID:41455152 | DOI:10.1016/j.jclinane.2025.112110
