Hussain Nasir, Brull Richard, Freedenberg Alex T, Vannabouathong Chris, D'Souza Ryan S, Havlik Steven, Beachy Peyton, Gunawan Antonius, Weaver Tristan E, McIsaac Daniel I, McCartney Colin J L, Abdallah Faraj W
Department of Anesthesiology, Ohio State University, Wexner Medical Center, Columbus, Ohio.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.
Anesthesiology. 2025 Sep 1;143(3):604-624. doi: 10.1097/ALN.0000000000005607. Epub 2025 Jun 9.
Periarticular local infiltration analgesia has become an important mainstay of multimodal analgesia after elective total hip arthroplasty (THA). However, the role of novel motor-sparing fascial plane blocks-with or without periarticular local infiltration analgesia-has not been fully elucidated for patients undergoing THA. The authors conducted a network meta-analysis evaluating the relative analgesic effectiveness of motor-sparing fascial plane blocks (quadratus lumborum, erector spinae, and pericapsular nerve group blocks) and periarticular local infiltration analgesia for adult patients undergoing THA.
Randomized trials examining single-injection quadratus lumborum, erector spinae, or pericapsular nerve group blocks, or periarticular local infiltration analgesia, for THA were sought. The primary outcome was area under the curve (AUC) rest pain scores during the period from 0 to 24 h. Secondary outcomes included rest pain scores at 0, 6, 12, and 24 h; postoperative function at 6, 12, and 24 h; analgesic consumption at 0 to 24 h; incidence of opioid-related side effects; and incidence of block-related complications. Network meta-analysis was performed using a frequentist approach.
A total of 44 trials (3,579 patients) evaluating the quadratus lumborum block, erector spinae block, pericapsular nerve group block, or periarticular local infiltration analgesia for THA were considered. Network meta-analysis was used to derive the probability of each intervention being the most effective as compared to the others (P score). For AUC 0 to 24 h rest pain, periarticular local infiltration analgesia was the most effective intervention, as demonstrated by a P score of 89%. For postoperative analgesic consumption, the quadratus lumborum block was the most effective intervention, with a P score of 88%. This was followed by the pericapsular nerve group block (74%), the erector spinae block (38%), and periarticular local infiltration analgesia (42%).
Periarticular local infiltration analgesia alone provides the most consistent improvements in postoperative rest pain, analgesic consumption, and functional recovery after THA. The addition of a quadratus lumborum block or pericapsular nerve group block to periarticular local infiltration may further improve analgesic outcomes.
关节周围局部浸润镇痛已成为择期全髋关节置换术（THA）后多模式镇痛的重要支柱。然而，对于接受THA的患者，新型保留运动功能的筋膜平面阻滞（无论是否联合关节周围局部浸润镇痛）的作用尚未完全阐明。作者进行了一项网状Meta分析，评估保留运动功能的筋膜平面阻滞（腰方肌、竖脊肌和关节周围神经组阻滞）和关节周围局部浸润镇痛对接受THA的成年患者的相对镇痛效果。
检索关于THA的单注射腰方肌、竖脊肌或关节周围神经组阻滞或关节周围局部浸润镇痛的随机试验。主要结局是0至24小时期间的曲线下面积（AUC）静息痛评分。次要结局包括0、6、12和24小时的静息痛评分；6、12和24小时的术后功能；0至24小时的镇痛药物消耗量；阿片类药物相关副作用的发生率；以及阻滞相关并发症的发生率。采用频率学派方法进行网状Meta分析。
共纳入44项评估THA的腰方肌阻滞、竖脊肌阻滞、关节周围神经组阻滞或关节周围局部浸润镇痛的试验（3579例患者）。采用网状Meta分析得出每种干预措施相对于其他措施最有效的概率（P值）。对于0至24小时AUC静息痛，关节周围局部浸润镇痛是最有效的干预措施，P值为89%表明了这一点。对于术后镇痛药物消耗量，腰方肌阻滞是最有效的干预措施，P值为88%。其次是关节周围神经组阻滞（74%）、竖脊肌阻滞（38%）和关节周围局部浸润镇痛（42%）。
单纯关节周围局部浸润镇痛在THA术后静息痛、镇痛药物消耗量和功能恢复方面提供了最一致的改善。在关节周围局部浸润镇痛基础上加用腰方肌阻滞或关节周围神经组阻滞可能进一步改善镇痛效果。
