Efficacy Of Preoperative Fascia Iliaca Compartment Block In Patients With Hip Fracture: A Meta-analysis

Objectives:It is estimated that by 2050,there will be 6.3 million hip fracture patients in the world each year,and perioperative pain control for hip fracture patients is a challenge.At present,most of the analgesia methods used are systemic analgesics or local nerve block techniques.Various local nerve blocks have been shown to be effective in alleviating preoperative pain in hip fracture patients,but whether fascia iliaca compartment block(FICB)technology could alleviate the intensity of pain in patients with hip fractures is still controversial.This article combined high-quality domestic and foreign literatures to explore the effects of preoperative FICB technique on pain control,opioid consumption and related adverse reactions in patients with hip fractures,then,provided reference basis for clinical application.Methods:We searched China National Knowledge Internet(CNKI),WANFANG medical network,VIP network,Google Scholar,Pub Med,Embase,Cochrane Library,web of science databases,and searched for eligible randomized controlled trials(RCTs)published since the establishment of the database until October 1,2020.Adult patients with hip fractures were included,the experimental group received FICB treatment before surgery,and the control group received standard analgesia,and studies using FICB combined with other nerve blocks for analgesia before surgery were excluded.We extracted the date which were the visual analog scale(VAS)score of the two groups of patients in the resting state and the exercise state before FICB,the VAS score1-8 hours,8th hour to before surgery after FICB,the consumption of opioids before surgey and related adverse reactions.The consumption of opioids was uniformly converted into intravenous morphine consumption,Rev Man 5.3 software and Stata SE 15 software were used to conduct meta-analysis on the extracted data,In all cases,P<0.05 was considered to be statistically significant.Subgroup analysis and sensitivity analysis were used to explore the source of heterogeneity,funnel chart was create to test the publication bias of the included literatures,and GRADE system was applied for evidence quality evaluation.Results:This study included 10 RCTs,with a total of 1182 samples,of which the total number of samples in the experimental group was 706 and in the control group was 476.1 Main indicators1.1 Compared with the control group,the pain score of the hip fracture patients in the resting state and the exercise state were significantly lower during 1-8 hours after the FICB was implemented before the operation(at rest:standardized mean difference(SMD)-0.78,95%confidence interval(CI)was-1.27~-0.28,P=0.002;during exercise:SMD-1.66,95%CI-2.84~-0.47,P=0.006).Subgroup analysis showed that compared with the control group,the pain score of the single block group,levobupivacaine group and ropivacaine group were significantly lower in the resting state,and the differences were statistically significant(single block group:SMD-0.32,95%CI-0.52~-0.12,P=0.002;levobupivacaine group:SMD-0.41,95%CI-0.59~-0.24,P<0.00001;ropivacaine group:SMD-1.37,95%CI-2.62~-0.13,P=0.03),although the continuous block group reduced the pain score,there was no statistical difference in intra-group comparison(SMD-1.87,95%CI-3.81~0.07,P=0.06);in the exercise state,the pain score of the continuous block group was significantly reduced,and the difference was statistically significant(SMD-2.10,95%CI-2.59~-1.62,P<0.00001),although the pain score was reduced in the single block group,there was no statistical difference in intra-group comparison(SMD-0.52,95%CI-1.11~-0.06,P=0.08).1.2 Compared with the control group,the pain score of the FICB group in resting state was significantly reduced from 8th hour to before surgery after FICB,and the difference was statistically significant(SMD-1.18,95%CI-2.01~-0.36,P=0.005).Subgroup analysis showed that compared with the control group,the pain score of the levobupivacaine group and ropivacaine group were both significantly lower,and the differences were statistically significant(levobupivacaine group:SMD-0.33,95%CI-0.53~-0.14,P=0.0007;ropivacaine group:SMD-1.83,95%CI-3.54~-0.11,P=0.04).1.3 Compared with the control group,the application of preoperative FICB could reduce the patients’ preoperative morphine consumption,and the difference was statistically significant(SMD-0.53,95%CI-0.80~-0.27,P<0.0001).Subgroup analysis showed that compared with the control group,morphine consumption in the levobupivacaine group was significantly reduced,and the differences were statistically significant(SMD-0.47,95%CI-0.65~-0.28,P<0.00001),although the ropivacaine group reduced the consumption of morphine,there was no statistical difference in intra-group comparison(SMD-0.52,95%CI-1.11~-0.06,P=0.08).2 Secondary indicator(adverse reactions)Compared with the control group,the preoperative FICB technology could significantly reduce the occurrence of adverse reactions in patients,and the difference was statistically significant(risk ratio(RR)0.51,95%CI0.35~0.75,P=0.0005).Subgroup analysis showed that compared with the control group,preoperative FICB treatment for hip fracture patients could significantly reduce the occurrence of delirium and nausea and vomiting,differences are statistically significant(delirium:RR 0.44,95%CI0.21~0.92,P=0.03;nausea and vomiting:RR 0.43,95%CI 0.20~0.89,P=0.02),no statistical difference in intra-group comparison was found in the reduction of opioid-related adverse reactions(RR 0.87,95%CI 0.47~1.60,P=0.65).Conclusions:Compared with the conventional opioid analgesia,the application of preoperative FICB technology in hip fracture patients could reduce the pain level of 1-8 hours after FICB in the resting state and the exercise state,from 8th hour to before surgery after FICB in the resting state,and reduce preoperative the consumption of morphine and the occurrence of adverse reactions.