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This meta-analysis of 6 RCTs (n=348) compared erector spinae plane block (ESPB) to fascia iliaca block (FIB) for analgesia in hip arthroplasty patients. ESPB significantly reduced the incidence of quadriceps motor block compared to FIB, but there were no significant differences in opioid consumption, time to first analgesia, or pain scores. ESPB appears to provide comparable analgesia to FIB with improved motor function preservation.
ESPB results in less quadriceps motor block compared to FIB without compromising analgesic efficacy in hip arthroplasty patients.
INTRODUCTION Hip arthroplasty is a frequently performed surgery that requires effective multimodal analgesia for optimal recovery and adherence to enhanced recovery after surgery protocols. Traditionally, spinal anesthesia with opioids has been the mainstay for postoperative pain management, but side effects have prompted increased use of peripheral nerve blocks. The fascia iliaca block (FIB) is a well-established technique recommended by PROSPECT guidelines, while the erector spinae plane block (ESPB) has recently emerged as a potential alternative. This systematic review and meta-analysis aimed to compare the efficacy of FIB and ESPB in patients undergoing hip arthroplasty. EVIDENCE ACQUISITION A comprehensive search of PubMed, Cochrane, and Embase identified six randomized controlled trials (RCTs) including 348 patients, evenly distributed between ESPB and FIB groups. Primary outcomes included incidence of motor block, cumulative opioid consumption, time to first rescue analgesia, and postoperative pain scores. EVIDENCE SYNTHESIS The analysis revealed that ESPB significantly reduced the incidence of quadriceps motor block compared to FIB, with a relative risk (RR) of 0.25 (95% CI, 0.13-0.49; P<0.001). Motor block occurred in 8.7% of ESPB patients versus 38.4% of FIB patients. However, there were no statistically significant differences between groups in 24-hour cumulative opioid consumption, time to first rescue analgesia, or pain scores at rest or during movement. CONCLUSIONS ESPB offers a clear advantage over FIB in preserving motor function without compromising analgesic efficacy. These findings support ESPB as a viable alternative to FIB in hip arthroplasty pain management protocols.
