A Bayesian network meta-analysis of peripheral nerve blocks for postoperative analgesia in adults following hip fracture surgery

Peripheral nerve blocks are an important component of postoperative pain management after hip fracture surgery. However, the optimal peripheral nerve block remains uncertain. This Bayesian network meta-analysis aimed to compare the analgesic effectiveness of commonly used peripheral nerve blocks and identify the most effective approach for postoperative pain control. The Cochrane Library, Embase, PubMed, CNKI, Wanfang, and Sinomed databases were searched from inception to October 2024. Randomized controlled trials involving adult patients undergoing hip fracture surgery and reporting 24-h postoperative opioid consumption, pain scores within 24 h, or time to first rescue analgesia were included. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0, and the certainty of evidence was evaluated using the Confidence in Network Meta-Analysis framework. Forty-four randomized controlled trials involving 3,292 patients and ten peripheral nerve blocks were included. Compared with control groups, most peripheral nerve blocks reduced opioid consumption within 24 h postoperatively. Quadratus lumborum block and erector spinae plane block reached the minimum clinically important difference (mean difference (MD), -37.51 [95% confidence interval (CI), -49.74 to -25.28]; MD, -31.28 [95% CI, -43.26 to -19.21], respectively). Paravertebral block, erector spinae plane block, and quadratus lumborum block significantly reduced 24-h pain scores (MD − 2.12, 95% CI − 3.84 to − 0.39; MD − 1.56, 95% CI − 2.49 to − 0.65; MD − 1.22, 95% CI − 2.08 to − 0.35, respectively), with paravertebral block and erector spinae plane block achieving the minimum clinically important difference. Quadratus lumborum block provided significant analgesia up to 12 h. Most peripheral nerve blocks prolonged the time to first rescue analgesia. Meta-regression and sensitivity analyses confirmed the robustness of the findings. No evidence of publication bias or small-study effects was identified. Erector spinae plane block, quadratus lumborum block, and paravertebral block may offer clinically meaningful postoperative analgesia for patients undergoing hip fracture surgery. However, the certainty of the evidence ranged from very low to low. Use of peripheral nerve blocks should be individualized within a multimodal analgesia approach, and further high-quality randomized controlled trials are needed to confirm these findings. PROSPERO register: CRD42024527147.