The efficacy of fascia iliaca compartment block for pain control after hip fracture

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Abstract

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Abstract

Background:

To assess the effect of fascia iliaca compartment block (FICB) on pain control and morphine consumption in patients with hip fracture.

Methods:

We searched databases (PubMed, Embase, Cochrane Library) for eligible randomized controlled trials (RCTs) published prior to September 12, 2018. We only included hip fracture patients who received FICB versus placebo for pain control. Risk ratios (RRs), standard mean differences (SMD) and 95% confidence intervals (CI) were determined. Stata 12.0 was used for the meta-analysis.

Results:

Eleven trials involving 937 patients underwent hip fracture were retrieved. FICB significantly decreased the pain intensity at 1–8 h (SMD = −1.03, 95% CI [−1.48, −0.58], P = .000), 12 h (SMD = −1.06, 95% CI [−1.36, −0.75], P = .000), 24 h (SMD = −1.14, 95% CI [−1.66, −0.62], P = .000) and 48 h (SMD = −0.96, 95% CI [−1.33, −0.60], P = .000). Moreover, FICB could reduced the total morphine consumption and the occurrence of nausea ( P < .05). There was no significant difference between the pain intensity at 72 h (SMD = 0.11, 95% CI [−0.12, 0.34], P = .355).

Conclusions:

FICB has a beneficial role in reducing pain intensity and morphine consumption after hip fracture. Moreover, FICB has morphine-sparing effects when compared with a control group. More high-quality RCTs are needed to identify the optimal technique and volume of injectate for FICB.

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Most cited references 26

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Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias.

Karsten Knobloch, Uzung Yoon, Peter Vogt (2011)

Publication bias is a major problem in evidence based medicine. As well as positive outcome studies being preferentially published or followed by full text publication authors are also more likely to publish positive results in English-language journals. This unequal distribution of trials leads to a selection bias in evidence l level studies, like systematic reviews, meta-analysis or health technology assessments followed by a systematic failure of interpretation and in clinical decisions. Publication bias in a systematic review occurs mostly during the selection process and a transparent selection process is necessary to avoid such bias. For systematic reviews/meta-analysis the PRISMA-statement (formerly known as QUOROM) is recommended, as it gives the reader for a better understanding of the selection process. In the future the use of trial registration for minimizing publication bias, mechanisms to allow easier access to the scientific literature and improvement in the peer review process are recommended to overcome publication bias. The use of checklists like PRISMA is likely to improve the reporting quality of a systematic review and provides substantial transparency in the selection process of papers in a systematic review. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial.

M Bundgaard, Sine Hougaard, M Bak … (2007)

Hip fracture patients are in severe pain upon arrival at the emergency department. Pain treatment is traditionally based on systemic opioids. No study has examined the effect of fascia iliaca compartment blockade (FICB) in acute hip fracture pain management within a double-blind, randomized setup. Forty-eight patients with suspected hip fracture were included immediately after arrival in the emergency department, before x-ray confirmation of their fracture. Included patients were randomly assigned to two groups of 24. In the FICB group, the patients received an FICB with 1.0% mepivacaine and a placebo intramuscular injection of isotonic saline. In the morphine group, the patients received a placebo FICB with 0.9% saline and an intramuscular injection of 0.1 mg/kg morphine. Patients received intravenous rescue morphine when necessary. Maximum pain relief was superior in the FICB group both at rest (P < 0.01) and on movement (P = 0.02). The median total morphine consumption was 0 mg (interquartile range, 0-0 mg) in the FICB group and 6 mg (interquartile range, 5-7 mg) in the morphine group (P < 0.01). More patients (P = 0.05) were sedated in the morphine group at 180 min after block placement as compared with the FICB group. Pain relief was superior at all times and at all measurements in the FICB group. The study supports the use of FICB in acute management of hip fracture pain because it is an effective, easily learned procedure that also may reduce opioid side effects in this fragile, elderly group of patients.

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Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study

George Mouzopoulos, George Vasiliadis, Nikolaos Lasanianos … (2009)

Background Recent studies have indicated that unmanaged pain, both acute and chronic, can affect mental status and might precipitate delirium, especially in elderly patients with hip fractures. The aim of this study was to assess the effectiveness of fascia iliaca compartment block (FICB) for prevention of perioperative delirium in hip surgery patients who were at intermediate or high risk for this complication. Materials and methods On admission, all included patients were divided into three groups according to low, intermediate or high risk for perioperative delirium. Eligible patients (those classified as at intermediate or high risk for developing delirium) were sequentially randomly assigned to study treatment (FICB prophylaxis or placebo) according to a computer-generated randomization code. The primary outcome was perioperative delirium. Diagnosis of the syndrome was defined using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and Confusion Assessment Method (CAM) criteria. Secondary outcome variables were severity of delirium and delirium duration. Results Delirium occurred in 33 (15.94%) out of 207 patients randomized to FICB prophylaxis or the placebo group. Incidence of delirium in the FICB prophylaxis group was 10.78% (11/102), significantly different from the incidence (23.8%, 25/105) in the placebo group [relative risk 0.45, 95% confidence interval (CI) 0.23–0.87]. Nine of 17 patients with high risk for delirium and included in the FICB prophylaxis group developed delirium, whereas 10 of 16 high-risk patients included in the placebo group became delirious (relative risk 0.84, CI 0.47–1.52). Two of 85 patients with intermediate risk for delirium and included in the FICB prophylaxis group developed delirium, whereas 15 of 89 intermediate-risk patients included in the placebo group became delirious (relative risk 0.13, CI 0.03–0.53). Severity of delirium according to the highest value of the DRSR-98 during an episode with delirium in patients in the FICB prophylaxis group was on average 14.34, versus 18.61 in the placebo group (mean difference 4.27, 95% CI 1.8–5.64, P < 0.001). Mean duration of delirium in the FICB prophylaxis group was significantly shorter than in the placebo group (FICB 5.22 days versus placebo 10.97 days, 95% CI 3.87–7.62, P < 0.001). Conclusion No significant difference was found among high-risk patients between FICB prophylaxis and placebo groups in terms of delirium incidence. However, FICB prophylaxis significantly prevented delirium occurrence in intermediate-risk patients. Thus FICB prophylaxis could be beneficial, particularly for intermediate-risk patients.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: July 2019

Publication date (Electronic): 12 July 2019

Volume: 98

Issue: 28

Electronic Location Identifier: e16157

Affiliations

Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China.

Author notes

[∗ ]Correspondence: Yi Ma, Department of Anesthesiology, Guizhou Provincial People's Hospital, No. 83, Zhongshan Dong Road, Guiyang, Guizhou Province, China (e-mail: qiaoci19920614@ 123456126.com ).

Article

Publisher ID: MD-D-18-09216 Accession ID: 16157

DOI: 10.1097/MD.0000000000016157

PMC ID: 6641663

PubMed ID: 31305398

SO-VID: 45eda1ac-de28-424e-9c97-358d9ac4b85b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

History

Date received : 10 December 2018

Date revision received : 27 March 2019

Date accepted : 31 May 2019

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Keywords: fascia iliaca compartment block,hip fracture,meta-analysis,pain control

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Keywords: fascia iliaca compartment block, hip fracture, meta-analysis, pain control

The efficacy of fascia iliaca compartment block for pain control after hip fracture : A meta-analysis

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Most cited references 26

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias.

Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial.

Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study

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