Fascia iliaca compartment block reduces pain and opioid consumption after total hip arthroplasty: A systematic review and meta-analysis

Background: Optimal pain management after total hip arthroplasty (THA) remains controversial. We perform a meta-analysis from randomized controlled trials (RCTs) to evaluate the efficacy and safety of fascia iliaca compartment block (FICB) in THA. Methods: In this meta-analysis, we conducted electronic searches of Pubmed, Medline, Cochrane library, and Web of Science before February 2019. We collected RCTs to compare FICB and placebo for pain control after THA. The outcome measurements consisted of pain score, opioid consumption, length of hospitalization and postoperative complications. All data analyses were conducted using STATA 13.0. Cochrane Collaboration's tool was adopted to assess the risk of bias. Results: Seven RCTs met our inclusion criteria with 165 patients in the FICB groups, and 160 patients in the placebo groups. The present meta-analysis indicated that there were significant differences between the groups in terms of pain score at postoperative 12 h (WMD = -0.285, 95% CI [-0.460, -0.109], P = 0.002) and 24 h (WMD = -0.391, 95% CI [-0.723, -0.059], P = 0.021). FICB was associated with significant superior in opioid consumption at postoperative 12 h (WMD = -5.394, 95% CI [-8.772, -2.016], P = 0.002) and 24 h (WMD = -6.376, 95% CI [-10.737, -2.016], P = 0.004) compared with placebo. No significant difference was identified regarding length of hospitalization (WMD = 0.112, 95% CI [-0.125, 0.350], P = 0.354). Conclusion: Fascia iliaca compartment block was effective for pain relief during the early post-operative period after total hip arthroplasty. Meanwhile, it reduced the cumulative morphine consumption and the risk of opioid-related adverse effects.