Objective: To systematically evaluate the efficacy of different analgesic methods in relieving the pain in hip and femoral shaft fractures patients during spinal anesthesia position by using network meta-analysis.
Methods: The articals of randomized controlled trials (RCTs) that analgesia was performed in patients with hip and femoral shaft fractures during the spinal anesthesia position placement were retrieved from the following database from the establishment of the database to August 2022, PubMed, the Cochrane Library, Web of Science, EMbase, China Biology Medicine (CBM), CNKI, VIP, and Wanfang databases. Literature screening, data extraction and bias risk assessment were conducted by two researchers separately. Stata 17.0 and RevMan 5.3 software were used for statistical analysis.
Results: A total of 28 RCTs with 1 773 patients were included. The surface under the cumulative ranking (SUCRA) curve showed that and PENG block (94.4%) had the best effect on reducing the VAS pain score of placement position, followed by FIB combined with IVA (83.8%) and FIB (71.1%), and PENG block (98.2%) had the best effect on reducing VAS pain score during spinal anesthesia, followed by FIB (71.1%) and FNB (55.6%), and PENG block (84.1%) had the best effect on shortening the time of spinal anesthesia operation, followed by FNB (70.7%) and FIB (68.5%), and PENG block (99.1%) had the best effect on improving the quality of positioning, followed by FIB (73.1%) and FNB (52.9%).
Conclusion: Nerve blocks or the combination with IVA can reduce pain scores during position placement and spinal anesthesia, shorten anesthesia operation time, and improve quality of position placement in patients with hip and femoral shaft fractures. PENG block has the best analgesic effect in patients with hip or femoral shaft fractures during positioning and spinal anesthesia. |
