Authors: Yang, Yanyan et al.
BMC Anesthesiology, Volume 25, Article 522 (2025).
This Bayesian network meta-analysis compared the efficacy of multiple peripheral nerve block techniques for postoperative pain management following total hip arthroplasty (THA). Eighteen randomized clinical trials from 12 countries, encompassing 1,180 patients, were included. The analysis evaluated 11 block types, focusing on 24-hour postoperative pain scores (dynamic and static), oral morphine equivalents (OME), and the incidence of postoperative nausea and vomiting (PONV).
Infrainguinal fascia iliaca compartment block (I_FICB) ranked highest for both dynamic (SUCRA 85.71%) and static (SUCRA 88.90%) pain reduction at 24 hours. Compared with suprainguinal FICB (S_FICB) and circum-psoas block (CPB), I_FICB produced significantly lower dynamic pain scores, and it also outperformed L4 erector spinae plane block (L4_ESPB) for static pain relief. Lumbar plexus block (LPB) was superior in reducing 24-hour OME (SUCRA 78.10%), while L4_ESPB had the lowest rates of PONV (SUCRA 81.22% for nausea; 76.09% for vomiting). Despite these trends, the certainty of evidence was rated low or very low due to heterogeneity among studies and small sample sizes.
The authors conclude that infrainguinal FICB may offer the most effective analgesia after THA, with LPB best minimizing opioid use and L4_ESPB most effective for reducing PONV. However, further large, high-quality randomized trials are warranted before definitive recommendations can be made.
What You Should Know
• Infrainguinal fascia iliaca block (I_FICB) ranked highest for reducing both dynamic and static pain at 24 hours post-THA.
• Lumbar plexus block (LPB) minimized opioid consumption, while L4 erector spinae plane block (L4_ESPB) best reduced nausea and vomiting.
• Overall evidence quality remains limited, emphasizing the need for larger, rigorously designed RCTs.
• Technique selection should consider patient factors, desired outcomes, and provider expertise.
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