Fascia iliaca compartment block versus intravenous analgesic for positioning of femur fracture patients before a spinal block A PRISMA-compliant meta-analysis

Background: Fascia iliaca compartment block (FICB) provides an analgesic option for positioning before spinal anesthesia in patients suffering from a femur fracture. The evidence supporting FICB is still not well established. The aim of our study is to assess the efficacy and safety of FICB comparing with intravenous analgesic (IVA) on the quality for positioning before spinal anesthesia in participants with a femur fracture. Methods: PubMed, Embase, and Scopus databases were interrogated from their inceptions to September 2017. We included randomized controlled studies reported as full text, those published as abstracts only and unpublished data, if available. Data were independently extracted by 2 reviewers and synthesized using a random-effects model. Main Results: Three studies comprising 141 participants showed that FICB compared to IVA led to a significant between-group standard mean differences in quality during positioning within 30minutes before spinal anesthesia (standardized mean difference (SMD) -2.02, 95% confidence interval (CI): -2.43 to -1.61, I-2 = 0%) and time for spinal anesthesia (pooled mean difference (PMD) -2.86 minutes, 95% CI -3.70 to -2.01, I-2 = 0%). Two studies with 101 participants suggested that FICB is superior to IVA on opioid requirements 24hours postoperatively (pooled odds ratio (POR): 0.11, 95% CI: 0.03 to 0.35, I-2 = 13%). There were no significant differences in complications or hemodynamic effects Conclusions: Comparing with IVA, FICB can provide significantly better quality during positioning of femur fracture patients for a spinal block and a shorter time for spinal anesthesia. FICB is safe method.