We conducted a systematic review and network meta-analysis to evaluate the comparative efficacy of peripheral nerve block types for preoperative pain management of hip fractures. We searched Cochrane, Central Register of Controlled Trials, MEDLINE, EMBASE, ICTRP, , and Google Scholar for randomized clinical trials. We included participants aged more than 16 years with hip fractures who received peripheral nerve blocks or analgesics for preoperative pain management. The primary outcomes were defined as absolute pain score 2 hours after block placement, preoperative consumption of morphine equivalents, and length of hospital stay. We used a random-effects network meta-analysis conceptualized in the Bayesian framework. Confidence of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). We included 63 randomized controlled studies (4,778 participants), of which only a few had a low risk of bias. The femoral nerve block, 3-in-1 block, fascia iliaca compartment block, and pericapsular nerve group block yielded significantly lowered pain scores at 2 hours after block placement compared with those with no block (standardized mean differences [SMD]: −1.1; 95% credible interval [CrI]: −1.7 to −0.48, [confidence of evidence: low]; SMD: −1.8; 95% CrI: −3.0 to −0.55, [low]; SMD: −1.4; 95% CrI: −2.0 to −0.72, [low]; SMD: −2.3; 95% CrI: −3.2 to −1.4, [moderate], respectively). The pericapsular nerve group block, 3-in-1 block, fascia iliaca compartment block, and femoral nerve block resulted in lower pain scores than the no-block group. Additionally, the pericapsular nerve group block yielded a lower pain score than femoral nerve block or fascia iliaca compartment block (SMD: −1.21; 95% CrI: −2.18 to −0.23, [very low]: SMD: −0.92; 95% CrI: −1.70 to −0.16, [low]). However, both the fascia iliaca compartment block and femoral nerve block did not show a reduction in morphine consumption compared with no block. To our knowledge, no studies have compared the pericapsular nerve group block with other methods regarding morphine consumption. Furthermore, no significant difference was observed between peripheral nerve blocks and no block in terms of the length of hospital stay. Compared with no block, preoperative peripheral nerve blocks for hip fractures appear to reduce pain 2 hours after block placement. Comparing different blocks, pericapsular nerve group block might be superior to fascia iliaca compartment block and femoral nerve block for pain relief, though the confidence evidence was low in most comparisons because of the moderate to high risk of bias in many of the included studies and the high heterogeneity of treatment strategies across studies. Therefore, further high-quality research is needed.

中文翻译：

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髋部骨折术前治疗中的周围神经阻滞：系统评价和网络荟萃分析

我们进行了系统回顾和网络荟萃分析，以评估周围神经阻滞类型对髋部骨折术前疼痛管理的比较疗效。我们检索了 Cochrane、对照试验中央注册库、MEDLINE、EMBASE、ICTRP、和 Google Scholar 的随机临床试验。我们纳入了 16 岁以上患有髋部骨折的参与者，他们在术前接受了周围神经阻滞或镇痛药治疗疼痛。主要结局定义为阻滞放置后 2 小时的绝对疼痛评分、术前吗啡当量消耗量以及住院时间。我们使用了贝叶斯框架中概念化的随机效应网络元分析。使用网络元分析置信度 (CINeMA) 评估证据的置信度。我们纳入了 63 项随机对照研究（4,778 名受试者），其中只有少数具有低偏倚风险。与未进行阻滞的患者相比，股神经阻滞、三合一阻滞、髂筋膜间隔阻滞和囊周神经组阻滞在阻滞放置后 2 小时的疼痛评分显着降低（标准化平均差 [S​​MD]：-1.1； 95% 可信区间 [CrI]：-1.7 至 -0.48，[证据置信度：低]；SMD：-1.8；95% CrI：-3.0 至 -0.55，[低]；SMD：-1.4；95% CrI：分别为-2.0至-0.72，[低]；SMD：-2.3；95% CrI：-3.2至-1.4，[中]。囊周神经阻滞、三合一阻滞、髂筋膜室阻滞和股神经阻滞组的疼痛评分低于无阻滞组。此外，囊周神经组阻滞的疼痛评分低于股神经阻滞或髂筋膜室阻滞（SMD：-1.21；95% CrI：-2.18 至 -0.23，[非常低]：SMD：-0.92；95% CrI ：-1.70 至 -0.16，[低]）。然而，与不进行阻滞相比，髂筋膜室阻滞和股神经阻滞均未显示吗啡消耗量减少。据我们所知，没有研究将囊周神经组阻滞与其他吗啡消耗方法进行比较。此外，在住院时间方面，周围神经阻滞和不阻滞之间没有观察到显着差异。与无阻滞相比，髋部骨折的术前周围神经阻滞似乎可以减轻阻滞放置后 2 小时的疼痛。比较不同的阻滞，在缓解疼痛方面，囊周神经组阻滞可能优于髂筋膜室阻滞和股神经阻滞，但由于许多纳入的研究中存在中度至高偏倚风险，大多数比较的置信度证据较低。不同研究中治疗策略的高度异质性。因此，需要进一步的高质量研究。