British journal of anaesthesia · 2025
Regional anaesthesia modalities for primary total hip arthroplasty: a systematic review and component network meta-analysis.
СтатьяNetwork Meta-AnalysisСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Lee Kun-Han, Wang Jui-Chien, Chang Cheng-Yang, Teng Wei-Nung, Wang Hsin-Yi, Lee Chien-Ching, Tsai Shang-Wen, Chen Cheng-Fong, Wu Po-Kuei, Chen Wei-Ming
Аннотация
BACKGROUND: Regional nerve blocks potentially offer superior pain control for patients undergoing primary total hip arthroplasty. However, the optimal single-shot regional anaesthesia modality remains unclear.
METHODS: PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to May 5, 2024. Randomised controlled trials comparing various single-shot regional anaesthesia modalities were included. Frequentist and component network meta-analyses were performed. The primary outcomes included static and dynamic pain (visual analogue scale [VAS]) at 6 and 12 h after operation and total morphine consumption at 24 h. Additional outcomes included opioid-related adverse effects, patient satisfaction, quality of recovery, and postoperative lower limb muscle power.
RESULTS: Eighty-seven randomised controlled trials were included. In static VAS, femoral nerve block ranked best (surface under the cumulative ranking curve (SUCRA)=92.8%), followed by lumbar plexus block (LPB) plus local infiltrative analgesia (LIA) (SUCRA=85.7%) at 6 h after operation. At 12 h after operation, LPB plus LIA was top ranked (SUCRA=89.2%), followed by quadratus lumborum block plus fascia iliaca compartment block (FICB) (SUCRA=84.8%). In dynamic VAS, pericapsular nerve group (PENG) block plus LIA (SUCRA=86.3%) and LPB plus LIA (SUCRA=83.4%) ranked best at 6 and 12 h after operation, respectively. In total morphine consumption at 24 h after operation, quadratus lumborum block plus FICB ranked highest (SUCRA=85.5%), followed by LPB plus LIA (SUCRA=82.2%) and PENG plus LIA (SUCRA=76.5%). LPB, FICB, and femoral nerve block were associated with increased motor blockade affecting quadriceps or adductor muscles based on qualitative analysis.
CONCLUSIONS: Combined regional anaesthesia modalities, particularly PENG plus LIA, are favourable options for primary total hip arthroplasty procedures, as they result in lower pain scores, reduced opioid consumption, and motor-sparing effects in the early postoperative period.
SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42024544358).
METHODS: PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to May 5, 2024. Randomised controlled trials comparing various single-shot regional anaesthesia modalities were included. Frequentist and component network meta-analyses were performed. The primary outcomes included static and dynamic pain (visual analogue scale [VAS]) at 6 and 12 h after operation and total morphine consumption at 24 h. Additional outcomes included opioid-related adverse effects, patient satisfaction, quality of recovery, and postoperative lower limb muscle power.
RESULTS: Eighty-seven randomised controlled trials were included. In static VAS, femoral nerve block ranked best (surface under the cumulative ranking curve (SUCRA)=92.8%), followed by lumbar plexus block (LPB) plus local infiltrative analgesia (LIA) (SUCRA=85.7%) at 6 h after operation. At 12 h after operation, LPB plus LIA was top ranked (SUCRA=89.2%), followed by quadratus lumborum block plus fascia iliaca compartment block (FICB) (SUCRA=84.8%). In dynamic VAS, pericapsular nerve group (PENG) block plus LIA (SUCRA=86.3%) and LPB plus LIA (SUCRA=83.4%) ranked best at 6 and 12 h after operation, respectively. In total morphine consumption at 24 h after operation, quadratus lumborum block plus FICB ranked highest (SUCRA=85.5%), followed by LPB plus LIA (SUCRA=82.2%) and PENG plus LIA (SUCRA=76.5%). LPB, FICB, and femoral nerve block were associated with increased motor blockade affecting quadriceps or adductor muscles based on qualitative analysis.
CONCLUSIONS: Combined regional anaesthesia modalities, particularly PENG plus LIA, are favourable options for primary total hip arthroplasty procedures, as they result in lower pain scores, reduced opioid consumption, and motor-sparing effects in the early postoperative period.
SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42024544358).