Background

Regional nerve blocks may be used as a component of a multimodal analgesic protocol to manage postoperative pain after primary total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after THA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.

Methods

We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published prior to March 24, 2020 on fascia iliaca, lumbar plexus, and quadratus lumborum blocks in primary THA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks.

Results

An initial critical appraisal of 3,382 publications yielded 11 publications representing the best available evidence for an analysis. Fascia iliaca, lumbar plexus, and quadratus lumborum blocks demonstrate the ability to reduce postoperative pain and opioid consumption. Among the available comparisons, no difference was noted between a regional nerve block or local periarticular anesthetic infiltration regarding postoperative pain and opioid consumption.

Conclusion

Local periarticular anesthetic infiltration should be considered prior to a regional nerve block due to concerns over the safety and cost of regional nerve blocks. If a regional nerve block is used in primary THA, a fascia iliaca block is preferred over other blocks due to the differences in technical demands and risks associated with the alternative regional nerve blocks.

中文翻译：

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全髋关节置换术中区域神经阻滞的疗效和安全性：系统评价和直接荟萃分析

背景

局部神经阻滞可用作多模式镇痛方案的一个组成部分，以管理初次全髋关节置换术 (THA) 后的术后疼痛。我们研究的目的是评估 THA 后局部神经阻滞的有效性和安全性，以支持美国髋膝关节外科医师协会、美国骨科医师学会、髋关节协会、膝关节协会和美国区域麻醉和疼痛管理学会。

方法

我们检索了 MEDLINE、Embase 和 Cochrane Central Register of Controlled Trials，以查找 2020 年 3 月 24 日之前发表的关于原发性 THA 中的髂筋膜、腰丛和腰方肌阻滞的研究。所有纳入的研究都进行了定性和定量同质性测试，然后进行了系统评价和直接比较荟萃分析，以评估区域神经阻滞的有效性和安全性。

结果

对 3,382 份出版物的初步批判性评估产生了 11 份出版物，代表了可用于分析的最佳证据。髂筋膜、腰丛和腰方肌阻滞显示出减少术后疼痛和阿片类药物消耗的能力。在可用的比较中，局部神经阻滞或局部关节周围麻醉剂浸润在术后疼痛和阿片类药物消耗方面没有差异。

结论

由于担心局部神经阻滞的安全性和成本，在局部神经阻滞之前应考虑局部关节周围麻醉剂浸润。如果在原发性 THA 中使用区域神经阻滞，由于技术要求和与替代区域神经阻滞相关的风险不同，髂筋膜阻滞优于其他阻滞。