髋关节囊周围神经阻滞与髂筋膜阻滞用于髋部骨折术后镇痛的效果比较:meta分析

Comparison of pericapsular nerve group block and fascia iliaca compartment block for analgesia following hip fracture surgery:a meta-analysis

目的采用meta分析比较髋关节囊周围神经(PENG)阻滞与髂筋膜阻滞(FICB)用于髋部骨折术后镇痛的效果。方法采用计算机检索Pubmed、Embase、Cochrane、中国知网、万方医学网、维普等数据库,纳入比较PENG阻滞组与FICB组在髋部骨折术后镇痛效果的随机对照试验。主要结局指标为术后疼痛评分,次要结局指标为术后镇痛药用量及术后不良反应发生率。检索时间截止2022年8月,结果采用Revman 5.4软件进行分析。结果共纳入8个研究(n=374),PENG阻滞组阻滞后30 min静态疼痛评分低于FICB组(MD=-0.35,95%CI-0.60~-0.11,I^(2)=14%,P<0.05);PENG阻滞组术后6、12、24和48 h静态与动态疼痛评分与FICB组比较差异无统计学意义(P>0.05);PENG阻滞组较FICB组术后24和48 h镇痛药物用量减少(MD=-9.10,95%CI-19.11~0.91,I2=95%,P<0.05);2组术后不良反应发生率比较差异无统计学意义(P>0.05)。结论PENG阻滞用于髋部骨折术后镇痛的效果优于FICB。

Objective To systematically compare the analgesic efficacy of pericapsular nerve group(PENG)block and fascia iliaca compartment block(FICB)after hip fracture surgery.Methods Databases including Pubmed,Embase,Cochrane,CNKI,Wanfang and VIP were searched for randomized controlled trials involving comparison of the analgesic efficacy of PENG block and FICB after hip fracture surgery from inception to August 2022.The primary outcome was the postoperative pain score,and the secondary outcome was the amount of postoperative analgesics and incidence of postoperative adverse reactions.The data were analyzed using Revman 5.4 software.Results Eight studies were included(n=374),and the pain score at rest 30 min after block was significantly lower in PENG group than in FICB group(MD=-0.35,95%CI-0.60--0.11,I2=14%,P<0.05).There was no statistically significant difference between PENG group and FICB group in pain scores at rest and during activity at 6,12,24 and 48 h after operation(P>0.05).Compared with FICB group,the amount of analgesics used was significantly reduced at 24 and 48 h after operation in PENG group(MD=-9.10,95%CI-19.11-0.91,I2=95%,P<0.05).There was no statistically significant difference in the incidence of adverse reactions after operation between the two groups(P>0.05).Conclusions PENG block provides better efficacy when used for analgesia following hip fracture than FICB.