The efficacy and safety of peripheral nerve blocks for postoperative analgesia following total hip arthroplasty: a network meta-analysis.

Background: Pain management following total hip arthroplasty (THA) remains challenging. Multiple peripheral nerve block techniques have emerged, but their comparative effectiveness requires systematic evaluation.

Methods: Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were systematically searched to identify relevant randomized clinical trials, with the time frame limited from database inception to November 2024. In this study, the primary outcomes were defined as 24-hour postoperative dynamic and static pain scores, while the secondary outcomes were 24-hour postoperative oral morphine equivalents (OME) and the incidence of postoperative nausea and vomiting. A Bayesian-based random-effects network meta-analysis was implemented. Results were reported as mean difference (MD) with 95% credible interval (CrI) or risk ratio (RR) with 95% CrI. The surface under the cumulative ranking curve (SUCRA) was used to rank interventions. Study quality was evaluated through the Cochrane Risk of Bias 2.0 (RoB2.0) tool. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was performed using this network meta-analysis (CINeMA) online tool.

Results: Our analysis incorporated data from 18 clinical trials spanning 12 countries, with 1,180 participants receiving 11 different nerve block interventions. Network meta-analysis results indicated that infrainguinal fascia iliaca compartment block (I_FICB) ranked highest for both 24-hour postoperative dynamic pain scores (SUCRA = 85.71%) and static pain scores (SUCRA = 88.90%). I_FICB was associated with lower 24-hour postoperative dynamic pain scores than suprainguinal fascia iliaca compartment block (S_FICB) (MD = -2.94, 95% CrI: -4.72, -1.16) and circum-psoas block (CPB) (MD = -2.37, 95% CrI: -4.18, -0.57). Additionally, I_FICB was associated with lower 24-hour postoperative static pain scores than L4 erector spinae plane block (L4_ESPB) (MD = -1.88, 95% CrI: -3.56, -0.20). Regarding other outcomes, lumbar plexus block (LPB) ranked first for 24-hour OME after surgery (SUCRA = 78.10%), while lumbar erector spinae plane block at the L4 vertebra level (L4_ESPB) ranked first for both postoperative nausea (SUCRA = 81.22%) and postoperative vomiting (SUCRA = 76.09%). The overall certainty of evidence for all these outcomes was rated as low or very low.

Conclusion: This meta-analysis indicated that among the various nerve block interventions included in this study for THA, I_FICB ranked highest in reducing 24-hour postoperative dynamic and static pain scores (SUCRA values: 85.71% and 88.90%, respectively), LPB ranked highest in reducing postoperative 24-hour OME (SUCRA value: 78.10%), and L4_ESPB ranked highest in controlling postoperative nausea and vomiting (SUCRA values: 81.22% and 76.09%, respectively). Further high-quality randomized controlled trials are needed to validate these findings.

Prospero registration number: CRD42025639677.