Systematic review and meta-analysis of single injection fascia iliaca blocks in the peri-operative management of patients with hip fractures

Abstract

Introduction: The aim of the study was to determine the analgesic efficacy and safety profile of single injection fascia iliaca compartment block (FICB) performed peri-operatively for isolated hip fractures.

Evidence acquisition: MEDLINE, EMBASE, Cochrane and CINAHL were searched from inception to February 2018. Inclusion criteria were: English language, adult patients (>18 years old), isolated traumatic hip fracture treated with single injection FICB peri-operatively. Data were extracted into a pre-piloted form that utilized the PRISMA-P 2015 checklist. Two investigators conducted reviews independently; any ambiguity was resolved by discussion. The quality of studies was assessed using the GRADE checklist and Cochrane risk of bias tool. A random-effects model was applied. Outcomes reviewed were pain level at rest and movement, breakthrough analgesia and complications.

Evidence synthesis: Out of 3757 citations, eight RCTs were included involving 645 participants. Pain was significantly reduced during movements (SMD=-1.82, 95% CI -2.26 to -1.38, P<0.00001) but not at rest (SMD=-0.68, 95% CI -1.70 to 0.35, P=0.20). FICB allowed less (breakthrough) supplemental analgesic (N.=57 vs. N.=73), however this did not reach statistical significance (P=0.19).

Conclusions: FICB is effective in controlling acute peri-operative pain in adult patients with traumatic hip fractures. The benefit is more evident during mobilization of the limb when compared to patients at rest.