Wu Jing, Mou Hongxia, Luo Xiaowei
Department of Anesthesiology, The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, XinDu Hospital of Traditional Chinese Medicine, Chengdu, China.
Medicine (Baltimore). 2025 Sep 5;104(36):e43744. doi: 10.1097/MD.0000000000043744.
With ultrasound-guided nerve block technology being increasingly used in hip surgery, the choice between fascia iliaca block (FIB) and lumbar plexus block (LPB) is still inconclusive. This study aims to evaluate the advantages and disadvantages of FIB and LPB in hip surgery.
PubMed, Web of Science, Cochrane Library, Embase, and CNKI were searched from inception to October 4, 2022. Two authors independently screened literature, extracted data, assessed study quality, and conducted meta-analysis using Review Manager 5.4.1. The heterogeneity was assessed by I2, and the fixed-effects model was applied when P > .05 and I2 < 50%; otherwise, the random-effects model was applied. For dichotomous variables, relative risk (RR) with 95% confidence interval (CI) was calculated. For the measured data, the standardized mean difference (SMD) with 95% CI were calculated, and statistical significance was set at P ≤ .05. Sensitivity analysis was performed by comparing results between fixed- and random-effects models.
In this comparative study of 639 patients (FIB group, n = 323; LPB group, n = 316) undergoing general anesthesia, 21 indices were analyzed via meta-analysis, with 12 showing heterogeneity and 7 lacking stability. FIB demonstrated superiority in ultrasound imaging time [SMD = -1.53, 95% CI (-1.93 to -1.13), P < .001], puncture time [SMD = -3.02, 95% CI (-4.12 to -1.91), P < .001], and length of stay [SMD = -0.43, 95% CI (-0.78 to -0.08), P = .02]. LPB outperformed in time to take effect [SMD = 1.76, 95% CI (0.13-3.39), P = .03], end-of-operation heart rate [SMD = 0.55, 95% CI (0.18-0.91), P = .03] and blood pressure [SMD = 0.88, 95% CI (0.51-1.26), P < .001], intraoperative sufentanil dose [SMD = 2.22, 95% CI (0.84-3.59), P = .002], 24-hour postoperative sufentanil dose [SMD = 1.80, 95% CI (0.17-3.42), P = .03], and postoperative 1-hour visual analogue scale (VAS) score [SMD = 0.48, 95% CI (0.16-0.80), P = .003]. No significant differences were observed in hemodynamics during laryngeal mask implantation or skin incision, remifentanil dose, patient-controlled analgesia (PCA) usage time, postoperative VAS scores at 6, 8, 12, 24, 48 hours, or adverse event incidence.
LPB significantly reduced intraoperative and postoperative opioid doses, and provided more stable hemodynamics at the end of surgery. FIB showed higher efficiency and shortened hospital stay. Anesthesiologists should select appropriate block techniques based on the unique advantages of different nerve blocks and patients' specific conditions.
随着超声引导下神经阻滞技术在髋关节手术中的应用日益广泛，髂筋膜阻滞（FIB）和腰丛阻滞（LPB）之间的选择仍无定论。本研究旨在评估FIB和LPB在髋关节手术中的优缺点。
检索PubMed、Web of Science、Cochrane图书馆、Embase和中国知网，检索时间从建库至2022年10月4日。两位作者独立筛选文献、提取数据、评估研究质量，并使用Review Manager 5.4.1进行荟萃分析。采用I²评估异质性，当P>0.05且I²<50%时应用固定效应模型；否则，应用随机效应模型。对于二分变量，计算相对危险度（RR）及95%置信区间（CI）。对于计量资料，计算标准化均数差（SMD）及95%CI，设定P≤0.05为有统计学意义。通过比较固定效应模型和随机效应模型的结果进行敏感性分析。
在这项对639例接受全身麻醉的患者（FIB组，n = 323；LPB组，n = 316）的比较研究中，通过荟萃分析分析了21项指标，其中12项显示存在异质性，7项缺乏稳定性。FIB在超声成像时间[SMD = -1.53，95%CI（-1.93至-1.13），P < 0.001]、穿刺时间[SMD = -3.02，95%CI（-4.12至-1.91），P < 0.001]和住院时间[SMD = -0.43，95%CI（-0.78至-0.08），P = 0.02]方面表现出优势。LPB在起效时间[SMD = 1.76，95%CI（0.13 - 3.39），P = 0.03]、手术结束时心率[SMD = 0.55，95%CI（0.18 - 0.91），P = 0.03]和血压[SMD = 0.88，95%CI（0.51 - 1.26），P < 0.001]、术中舒芬太尼剂量[SMD = 2.22，95%CI（0.84 - 3.59），P = 0.002]、术后24小时舒芬太尼剂量[SMD = 1.80，95%CI（0.17 - 3.42），P = 0.03]以及术后1小时视觉模拟评分（VAS）[SMD = 0.48，95%CI（0.16 - 0.80），P = 0.003]方面表现更优。在喉罩置入或皮肤切开时的血流动力学、瑞芬太尼剂量、患者自控镇痛（PCA）使用时间、术后6、8、12、24、48小时的VAS评分或不良事件发生率方面未观察到显著差异。
LPB显著降低了术中和术后的阿片类药物剂量，并在手术结束时提供了更稳定的血流动力学。FIB显示出更高的效率并缩短了住院时间。麻醉医生应根据不同神经阻滞的独特优势和患者的具体情况选择合适的阻滞技术。
