Erector spinae plane block versus fascia iliaca block for hip arthroplasty: a systematic review and meta-analysis

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