Comparison between lumbar plexus block and fascia iliaca block in hip surgery: A systematic review and meta-analysis

With ultrasound-guided nerve block technology being increasingly used in hip surgery, the choice between fascia iliaca block (FIB) and lumbar plexus block (LPB) is still inconclusive. This study aims to evaluate the advantages and disadvantages of FIB and LPB in hip surgery.

PubMed, Web of Science, Cochrane Library, Embase, and CNKI were searched from inception to October 4, 2022. Two authors independently screened literature, extracted data, assessed study quality, and conducted meta-analysis using Review Manager 5.4.1. The heterogeneity was assessed by I2, and the fixed-effects model was applied when P > .05 and I2 < 50%; otherwise, the random-effects model was applied. For dichotomous variables, relative risk (RR) with 95% confidence interval (CI) was calculated. For the measured data, the standardized mean difference (SMD) with 95% CI were calculated, and statistical significance was set at P ≤ .05. Sensitivity analysis was performed by comparing results between fixed- and random-effects models.

In this comparative study of 639 patients (FIB group, n = 323; LPB group, n = 316) undergoing general anesthesia, 21 indices were analyzed via meta-analysis, with 12 showing heterogeneity and 7 lacking stability. FIB demonstrated superiority in ultrasound imaging time [SMD = -1.53, 95% CI (-1.93 to -1.13), P < .001], puncture time [SMD = -3.02, 95% CI (-4.12 to -1.91), P < .001], and length of stay [SMD = -0.43, 95% CI (-0.78 to -0.08), P = .02]. LPB outperformed in time to take effect [SMD = 1.76, 95% CI (0.13-3.39), P = .03], end-of-operation heart rate [SMD = 0.55, 95% CI (0.18-0.91), P = .03] and blood pressure [SMD = 0.88, 95% CI (0.51-1.26), P < .001], intraoperative sufentanil dose [SMD = 2.22, 95% CI (0.84-3.59), P = .002], 24-hour postoperative sufentanil dose [SMD = 1.80, 95% CI (0.17-3.42), P = .03], and postoperative 1-hour visual analogue scale (VAS) score [SMD = 0.48, 95% CI (0.16-0.80), P = .003]. No significant differences were observed in hemodynamics during laryngeal mask implantation or skin incision, remifentanil dose, patient-controlled analgesia (PCA) usage time, postoperative VAS scores at 6, 8, 12, 24, 48 hours, or adverse event incidence.

LPB significantly reduced intraoperative and postoperative opioid doses, and provided more stable hemodynamics at the end of surgery. FIB showed higher efficiency and shortened hospital stay. Anesthesiologists should select appropriate block techniques based on the unique advantages of different nerve blocks and patients' specific conditions.