Second Department of Orthopaedics, Wenzhou City Central Hospital, Wenzhou, China.
Department of Nursing, Yueqing Panshi Town Health Center, Wenzhou, China.
Int Wound J. 2024 Feb;21(2):e14637. doi: 10.1111/iwj.14637.
Hip fracture surgeries are challenging, with postoperative pain management being a critical component of patient care. This systematic review and meta-analysis aimed to compare the effectiveness of Pericapsular nerve group block (PENGB) and fascia iliac compartment block (FICB) in postoperative wound pain management for patients undergoing hip fracture surgery. The study followed the PRISMA guidelines and was structured around the PICO framework. Comprehensive searches were conducted across PubMed, Embase, Web of Science, and the Cochrane Library. Inclusion criteria were limited to RCTs comparing the effectiveness of PENGB and FICB in adult patients undergoing hip fracture surgery. Key outcomes included pain control effectiveness, safety, and complication incidence. The quality of studies was assessed using the Cochrane Collaboration's risk of bias tool. Statistical heterogeneity was evaluated using I statistics, and meta-analysis effect values were calculated using random-effects or fixed-effect models, depending on the degree of heterogeneity. The search identified 1095 articles, with 5 studies meeting inclusion criteria. The meta-analysis revealed that PENGB and FICB were comparable in managing postoperative pain and opioid consumption. However, PENGB significantly reduced the incidence of quadriceps muscle weakness (RR = 0.12, p < 0.05) and did not increase the risk of PONV (RR = 1.36, p = 0.51), suggesting its advantage in maintaining motor function without adding to PONV complications. No significant publication bias was detected. PENGB is comparable to FICB in pain and opioid consumption management after hip fracture surgeries. Its significant benefit lies in reducing the incidence of quadriceps muscle weakness, facilitating better postoperative mobility. Additionally, PENGB does not increase the risk of postoperative nausea and vomiting, underlining its suitability for comprehensive postoperative care in hip fracture patients.
髋关节骨折手术具有挑战性，术后疼痛管理是患者护理的关键组成部分。本系统评价和荟萃分析旨在比较囊周神经群阻滞（PENGB）和髂筋膜间隙阻滞（FICB）在髋关节骨折手术患者术后伤口疼痛管理中的效果。该研究遵循 PRISMA 指南，并围绕 PICO 框架构建。全面检索了 PubMed、Embase、Web of Science 和 Cochrane Library。纳入标准仅限于比较 PENGB 和 FICB 对接受髋关节骨折手术的成年患者有效性的 RCT。主要结局包括疼痛控制效果、安全性和并发症发生率。使用 Cochrane 协作风险偏倚工具评估研究质量。使用 I 统计量评估统计学异质性，并根据异质性程度使用随机效应或固定效应模型计算荟萃分析效应值。搜索共确定了 1095 篇文章，其中 5 项研究符合纳入标准。荟萃分析表明，PENGB 和 FICB 在管理术后疼痛和阿片类药物消耗方面具有可比性。然而，PENGB 显著降低了股四头肌无力的发生率（RR=0.12，p<0.05），且并未增加术后恶心呕吐（PONV）的风险（RR=1.36，p=0.51），这表明其在不增加 PONV 并发症的情况下维持运动功能的优势。未检测到显著的发表偏倚。PENGB 在髋关节骨折手术后的疼痛和阿片类药物消耗管理方面与 FICB 相当。其显著优势在于降低股四头肌无力的发生率，从而促进更好的术后活动能力。此外，PENGB 不会增加术后恶心和呕吐的风险，强调其在髋关节骨折患者的综合术后护理中的适用性。
