Prakash Jay, Rochwerg Bram, Saran Khushboo, Yadav Arun K, Bhattacharya Pradip Kumar, Kumar Amit, Chaudhuri Dipayan, Priye Shio
Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Department of Medicine (Division of Critical Care), McMaster University, Hamilton, Ontario, Canada.
Indian J Anaesth. 2023 Nov;67(11):962-972. doi: 10.4103/ija.ija_672_23. Epub 2023 Nov 7.
Postoperative pain for patients having hip arthroplasty ranges from moderate to severe. Many regional anaesthesia procedures treat postoperative pain to improve functional ability and quality of life. Evidence comparing the analgesic effects of the pericapsular nerve group (PENG) block and fascia iliaca compartment block (FICB) remains unclear. The analgesic efficacies of PENG and FICB in hip arthroplasty were compared to determine which technique is associated with superior analgesia.
The electronic databases (PubMed, Cochrane Library, Google Scholar and Web of Sciences) were searched for published randomised controlled trials (RCTs) till 5 April 2023 comparing PENG block vs. FICB following hip arthroplasty. The primary outcome was pain scores [numerical rating scale (NRS) or visual analogue scale (VAS)] between 0 and 10 at rest and during movement at 24 h. Secondary outcomes included pain scores at rest and during movement within 30 min, at 6 h and 12 h, time to first rescue analgesia and cumulative postoperative opioid use in 24 h. We assessed the risk of bias using the Cochrane Collaboration Risk-of-Bias 2 tool. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the certainty of the evidence was assessed. Subgroup analysis was performed to explore the source of heterogeneity.
We included 12 RCTs examining 644 patients. Pain scores at rest at 24 h (standardised mean differences (SMDs): 0.17; 95% confidence interval (CI): -0.90 to 1.23; P = 0.76, moderate certainty) and during movement at 24 h (SMD: -0.58, 95% CI: -1.53 to 0.38, P = 0.24, moderate certainty) were not different in both PENG block and FICB. Pain scores at rest and during movement within 30 min may be lower with PENG block than FICB. However, the pain score at rest and during movement at 6 h and the time to first rescue analgesia were not different between the two treatment arms. The mean opioid consumption in oral morphine equivalents (mg) in 24 h may be lower with PENG than FICB.
We observed no difference between the PENG block and the FICB at 24 h for pain at rest and movement with a moderate degree of certainty. However, PENG block showed improved analgesia within 30 min at rest and during movement, and reduce postoperative opioid consumption in 24 h with moderate certainty of evidence. Further large-scale and high-quality RCTs are required to supplement the present findings.
髋关节置换术患者术后疼痛程度从中度到重度不等。许多区域麻醉方法可用于治疗术后疼痛，以提高功能能力和生活质量。比较关节周围神经组（PENG）阻滞和髂筋膜间隙阻滞（FICB）镇痛效果的证据仍不明确。比较PENG和FICB在髋关节置换术中的镇痛效果，以确定哪种技术具有更好的镇痛效果。
检索电子数据库（PubMed、Cochrane图书馆、谷歌学术和科学网），查找截至2023年4月5日发表的比较髋关节置换术后PENG阻滞与FICB的随机对照试验（RCT）。主要结局是术后24小时静息和活动时的疼痛评分[数字评分量表（NRS）或视觉模拟量表（VAS）]，范围为0至10分。次要结局包括30分钟内、6小时和12小时静息和活动时的疼痛评分、首次使用补救镇痛的时间以及术后24小时阿片类药物的累积使用量。我们使用Cochrane协作偏倚风险2工具评估偏倚风险。采用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。进行亚组分析以探索异质性来源。
我们纳入了12项RCT，共644例患者。PENG阻滞和FICB在术后24小时静息时的疼痛评分（标准化均数差（SMD）：0.17；95%置信区间（CI）：-0.90至1.23；P = 0.76，中等确定性）和活动时的疼痛评分（SMD：-0.58，95%CI：-1.53至0.38，P = 0.24，中等确定性）无差异。PENG阻滞在30分钟内静息和活动时的疼痛评分可能低于FICB。然而，两组在6小时静息和活动时的疼痛评分以及首次使用补救镇痛的时间并无差异。PENG组术后24小时口服吗啡当量（mg）的平均阿片类药物消耗量可能低于FICB组。
我们有中等程度的确定性观察到，PENG阻滞和FICB在术后24小时静息和活动时的疼痛方面没有差异。然而，PENG阻滞在静息和活动30分钟内显示出更好的镇痛效果，并且有中等确定性的证据表明其可减少术后24小时阿片类药物的消耗量。需要进一步的大规模高质量RCT来补充目前的研究结果。
