Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jul;96(27):e7382.
doi: 10.1097/MD.0000000000007382.

Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty: A meta-analysis from randomized controlled trials

Xin Wang  1 , Yuan Sun, Li Wang, Xuelian Hao
Affiliations
Review

Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty: A meta-analysis from randomized controlled trials

Xin Wang et al. Medicine (Baltimore). 2017 Jul.

Abstract

Background: This meta-analysis aimed to perform a meta-analysis to compare the efficiency and safety between femoral nerve block (FNB) and fascia iliaca block (FIB) for postoperative pain control in patients undergoing total knee and hip arthroplasties.

Methods: A systematic search was performed in Medline (1966-2017.05), PubMed (1966-2017.05), Embase (1980-2017.05), ScienceDirect (1985-2017.05) and the Cochrane Library. Inclusion criteria (1) Participants: Only published articles enrolling adult participants that with a diagnosis of end-stage of osteoarthritis and prepared for unilateral TKA or THA; (2) Interventions: The intervention group received FIB for postoperative pain management; (3) Comparisons: The control group was received FNB for postoperative pain control; (4) Outcomes: Visual analogue scale (VAS) scores in different periods, opioids consumption, length of stay and postoperative complications; (5) Study design: clinical randomized control trials (RCTs) were regarded as eligible in our study. Cochrane Hand book for Systematic Reviews of Interventions was used for assessment of the included studies and risk of bias was shown. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed. Meta-analysis was performed using Stata 11.0 software.

Results: Five RCTs including 308 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = -0.080, 95% CI: -0.306 to 0.145, P = .485), 24 hours (SMD = 0.098, 95% CI: -0.127 to 0.323, P = .393), and 48 hours (SMD = -0.001, 95% CI: -0.227 to 0.225, P = .993). No significant differences were found regarding opioid consumption at 12 hours (SMD = 0.026, 95% CI: -0.224 to 0.275, P = .840), 24 hours (SMD = 0.037, 95% CI: -0.212 to 0.286, P = .771), and 48 hours (SMD = -0.016, 95% CI: -0.265 to 0.233, P = .900). In addition, no significant increase of complications was identified between groups.

Conclusion: There is no significant differences of VAS scores at 12-48 hour and opioids consumption at 12-48 hour between two groups following total joint arthroplasty. No increased risk of nausea, vomiting and pruritus was observed in both groups. More high-quality large RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of FNB with FIB. The present meta-analysis exists some limitations that should be noted: (1) Only five articles were included in present meta-analysis, although all of them are recently published RCTs, the sample size are relatively small; (2) Functional outcome is an important parameter, due to the insufficiency of relevant data, we cannot perform a meta-analysis. (3) Dose and types of local anesthetics are varied, which may influence the results; (4) The duration of follow up is relatively short which leads to underestimating complications. (5) Publication bias in present meta-analysis may influence the results.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Search results and the selection procedure.
Figure 2
Figure 2
Forest plot diagram showing VAS scores at 12 hours following TJA.
Figure 3
Figure 3
Forest plot diagram showing VAS scores at 24 hours following TJA.
Figure 4
Figure 4
Forest plot diagram showing VAS scores at 48 hours following TJA.
Figure 5
Figure 5
Forest plot diagram showing opioid consumption at 12 hours following TJA.
Figure 6
Figure 6
Forest plot diagram showing opioid consumption at 24 hours following TJA.
Figure 7
Figure 7
Forest plot diagram showing opioid consumption at 48 hours following TJA.
Figure 8
Figure 8
Forest plot diagram showing length of hospital stay following TJA.
Figure 9
Figure 9
Forest plot diagram showing the incidence of nausea and vomiting following TJA.
Figure 10
Figure 10
Forest plot diagram showing the incidence of pruritus following TJA.
Figure 11
Figure 11
Funnel plot of VAS score at 24 hours.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Li JF, Li H, Zhao H, et al. Combined use of intravenous and topical versus intravenous tranexamic acid in primary total knee and hip arthroplasty: a meta-analysis of randomised controlled trials. J Orthop Surg Res 2017;12:22. - PMC - PubMed
    1. Petis SM, Howard JL, Lanting BA, et al. In-hospital cost analysis of total hip arthroplasty: does surgical approach matter? J Arthroplasty 2016;31:53–8. - PubMed
    1. Hadzic A, Houle TT, Capdevila X, et al. Femoral nerve block for analgesia in patients having knee arthroplasty. Anesthesiology 2010;113:1014–5. - PubMed
    1. Singelyn FJ, Ferrant T, Malisse MF, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Reg Anesth Pain Med 2005;30:452–7. - PubMed
    1. Duellman TJ, Gaffigan C, Milbrandt JC, et al. Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty. Orthopedics 2009;32:167. - PubMed