Regional anesthesia of the hip joint: review of regional anesthesia techniques

Introduction: As hip fractures are frequent in the frail population, multiple regional anesthesia approaches have been developed over the past years to achieve analgesia of the hip joint. Achieving optimal analgesia with opioid reduction remains challenging in this group with high morbidity and mortality. Many techniques have changed over the years due to the introduction of ultrasound and an optimisation of radiographic techniques such as MRI. There has been an upcoming interest in the fascia iliaca compartment block (FICB), local infiltration analgesia (LIA) and more recently the pericapsular nerve group block (PENG block). The aim of this review is to clarify the role of these techniques in hip surgery. Methods : A systematic search was performed in Medline, Embase and the Cochrane database, with the following MeSH terms: conduction anesthesia, nerve block, local anesthesia. Results: There is increasing evidence that a suprainguinal approach of the FICB is a valuable alternative for hip analgesia, as there is more success in blocking the three targeted nerves (femoral, obturator and lateral femoral cutaneous nerve), compared to the classical infra-inguinal approach. Very recently, the pericapsular nerve group block has seemed a promising option in providing analgesia of the hip joint, compared to LIA. Conclusion: both the FICB as well as the PENG block have been shown to be safe and effective analgesic options in hip fracture. However, more research is needed to determine the role of both techniques in different hip conditions.