Femoral nerve block versus fascia iliaca block for pain control in knee and hip arthroplasties

Abstract

Supplemental Digital Content is available in the text Abstract Background: This meta-analysis aimed to compare the efficiency of fascia iliaca compartment block (FICB) and femoral nerve block (FNB) for pain management in knee and hip surgeries. Methods: We searched four electronic databases (Pubmed, Embase, Cochrane library database, Web of Science) from inception to January 2019. Only randomized controlled trials (RCTs) were included. Two review authors independently extracted data for each included study. Primary outcomes were visual analogue scale at 12\u200ahours, 24\u200ahours, 48\u200ahours, total morphine consumption, the length of hospital stay and the occurrence of nausea and vomiting. Standardized mean difference (SMD) or risk ratio (RR) and 95% confidence intervals (CIs) were calculated for continuous outcomes and discontinuous outcomes respectively. We used the Cochrane Risk of Bias tool to assess risk of bias. Stata 12.0 was used for meta-analysis. Results: Finally, 7 RCTs involving 508 patients (FICB\u200a=\u200a254, FNB\u200a=\u200a254) were included in this meta-analysis. Compared with FNB group, FICB has no benefit for visual analogue scale at 12\u200ahours (SMD\u200a=\u200a0.02, 95% CI, −0.15 to 0.19; P\u200a=\u200a.820), 24\u200ahours (SMD\u200a=\u200a−0.02, 95% CI, −0.22 to 0.18; P\u200a=\u200a.806), and 48\u200ahours (SMD\u200a=\u200a−0.02, 95% CI, −0.22 to 0.19; P\u200a=\u200a.872). No significant differences were found regarding total morphine consumption (SMD\u200a=\u200a−0.07, 95% CI, −0.29 to 0.15; P\u200a=\u200a.533). What s more, there was no significant difference between the length of hospital stay and the occurrence of nausea and vomiting (P\u200a>\u200a.05). Conclusion: FICB has equivalent pain control and morphine-sparing efficacy when compared with FNB. More high-quality RCTs are needed to identify the optimal drugs and volume of local infiltration protocols.