Comparative efficacy of different nerve block technologies for postoperative pain management in hip arthroplasty: a network meta-analysis

Eur J Med Res. 2026 Feb 5. doi: 10.1186/s40001-026-03996-8. Online ahead of print.

ABSTRACT

BACKGROUND: Effective pain management following hip arthroplasty is critical for patient recovery. As a key component of multimodal analgesia strategies, nerve blocks are widely utilized for postoperative analgesia. However, the comparative efficacy of different nerve block techniques remains unclear. This study employs a Bayesian network meta-analysis (NMA) to compare analgesic outcomes among six commonly used nerve block techniques after hip arthroplasty.

METHODS: Randomized controlled trials (RCTs) comparing postoperative pain outcomes among six nerve block techniques-supra-inguinal fascia iliaca block (FIB), erector spinae plane block (ESPB), quadratus lumborum block (QLB), pericapsular nerve group block (PENG), lumbar plexus block (LPB), and circum-psoas block (CPB)-after hip arthroplasty were systematically searched in PubMed, Embase, Web of Science, and the Cochrane Library from inception to October 15, 2024. 15 RCTs involving 1,068 patients were included. Methodological quality and evidence certainty were assessed using Cochrane RoB 2.0 and GRADE framework. A Bayesian NMA with random/fixed-effects models integrated direct and indirect evidence. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA). Outcomes included static/dynamic pain scores at 12 and 24 h, 24-h intravenous morphine consumption, and postoperative adverse effects (nausea, vomiting, and dizziness).Data were analyzed using R 4.4.1 and Stata 15.

RESULTS: 15 RCTs (n = 1068) comparing six nerve block techniques were included. The NMA showed no statistically significant differences in static or dynamic pain scores at 12 or 24 h. For 24-h morphine consumption, CPB was associated with significantly lower use compared to QLB and FIB. Statistically significant differences were found for postoperative adverse effects. SUCRA rankings consistently indicated CPB had the highest probability of being among the most effective options across outcomes, followed by PENG. The overall certainty of evidence was moderate.

CONCLUSIONS: This NMA found no significant differences in analgesia among six nerve blocks after hip arthroplasty, but SUCRA rankings suggest CPB may be optimal for analgesia, morphine-sparing and postoperative adverse effects, while PENG may serve as an alternative in selected clinical contexts.

REGISTRATION: PROSPERO (CRD420251101790).

PMID:41645263 | DOI:10.1186/s40001-026-03996-8