Analgesic strategies prior to spinal anesthesia for patients with hip and femoral shaft fractures: A network meta-analysis of randomized controlled trials.
Systematic Review
The aim of this study was to compare the analgesic efficacy of different strategies at various perioperative stages in patients with hip or femoral shaft fractures, and to identify the optimal prespinal anesthesia analgesic approach./r/nA systematic search was conducted in PubMed, Cochrane, MEDLINE, Web of Science, and Embase for randomized controlled trials published up to July 2025. A network meta-analysis was performed using Stata 17.0 to assess the effectiveness of 4 analgesic methods – pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block, and intravenous analgesia – across 6 outcomes: Visual Analog Scale (VAS) score during positioning, quality of patient positioning, time to perform spinal anesthesia, VAS score during anesthesia, patient satisfaction, and postoperative morphine consumption./r/nA total of 23 randomized controlled trials involving 1359 patients were included. The PENG block demonstrated the most favorable performance in most intraoperative-related outcomes, with surface under the cumulative ranking curve values of 96.6% for positioning VAS, 97.6% for positioning quality, 83.9% for anesthesia procedure time, 88.0% for VAS during anesthesia, and 91.7% for patient satisfaction. FICB ranked highest in minimizing postoperative morphine consumption (surface under the cumulative ranking curve: 92.5%). Different analgesic strategies showed varied efficacy across outcome measures./r/nThe PENG block offers significant advantages in intraoperative analgesia and patient cooperation, while FICB is more effective in sustaining postoperative pain control. These findings provide robust evidence to guide the individualized selection of perioperative analgesic strategies.
