Abstract
BackgroundThe primary aim of this systematic review and meta-analysis was to compare postoperative pain, analgesic consumption, and complications after fascia iliaca block (FIB) versus control for patients undergoing primary total hip arthroplasty (THA). Second, we compared the outcomes of FIB versus placebo. Finally, we sought to evaluate pain and analgesic consumption after preoperative and postoperative FIB.MethodsWe performed a systematic literature search in MEDLINE, Embase, Scopus, Web of Science, Google Scholar, ClinicalTrials.gov, and CENTRAL through February 2021 to identify randomized controlled trials (RCTs) that evaluated the efficacy of FIB versus control for patients undergoing primary THA. All analyses were conducted on intent-to-treat data with a random-effects model.ResultsTwelve RCTs with a total of 815 patients were included. There was no difference in postoperative pain (P = 0.64), analgesic consumption (P = 0.14), or complication rate (P = 0.99) between FIB and control groups. Moreover, no difference in postoperative pain (P = 0.26), analgesic consumption (P = 0.06), or complication rate (P = 0.71) was found between FIB and placebo. Moreover, sensitivity analysis suggested that no significant difference in postoperative pain, analgesic consumption, or complication rate was present between FIB and control in studies that used preoperative and postoperative FIB.ConclusionFIB was not found to be superior to placebo or various anesthetic techniques for patients undergoing primary THA, as measured by postoperative pain, analgesic consumption, and complications.
Highlights
Postoperative pain is a significant concern for patients undergoing primary total hip arthroplasty (THA) [1]
FIB fascia iliaca block, LPB lumbar plexus block, GA general anesthesia, Patient-controlled intravenous analgesia (PCIA) patient-controlled intravenous analgesia, randomized controlled trials (RCTs) randomized controlled trial a similar pain relief at 24 h compared with the control group (SMD 0.11, 95% confidence interval (CI) −0.36 to 0.58; P = 0.64) (Fig. 3)
The overall pooled effect showed that there was no significant difference in pain relief at 24 h (SMD 0.51, 95% CI −0.38 to 1.39; P = 0.26; I2 = 94%), opioid consumption during the first 24 h (SMD −1.20, 95% CI −2.45 to 0.05; P = 0.06; I2 = 96%), or complication rate (RR 0.84, 95% CI 0.33 to 2.12; P = 0.71; I2 = 78%) between FIB and placebo
Summary
Postoperative pain is a significant concern for patients undergoing primary total hip arthroplasty (THA) [1]. Patient outcomes, including increased patient satisfaction, early participation in physical therapy, and a faster return to self-care, are influenced by postoperative pain control [2]. Patients can receive a multimodal drug regimen, ice, and physical therapy. Peripheral nerve blocks are another option to help control pain postoperatively. There is currently little evidence for routine use of nerve blocks after THA, there have been several reports of the use of nerve blocks to decrease pain after total knee and shoulder arthroplasty [6, 7]. The primary aim of this systematic review and meta-analysis was to compare postoperative pain, analgesic consumption, and complications after fascia iliaca block (FIB) versus control for patients undergoing primary total hip arthroplasty (THA). We sought to evaluate pain and analgesic consumption after preoperative and postoperative FIB
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