Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty

Abstract

Background:This meta-analysis aimed to perform a meta-analysis to compare the efficiency and safety between femoral nerve block (FNB) and fascia iliaca block (FIB) for postoperative pain control in patients undergoing total knee and hip arthroplasties.Methods:A systematic search was performed in Medline (1966-2017.05), PubMed (1966-2017.05), Embase (1980-2017.05), ScienceDirect (1985-2017.05) and the Cochrane Library. Inclusion criteria (1) Participants: Only published articles enrolling adult participants that with a diagnosis of end-stage of osteoarthritis and prepared for unilateral TKA or THA; (2) Interventions: The intervention group received FIB for postoperative pain management; (3) Comparisons: The control group was received FNB for postoperative pain control; (4) Outcomes: Visual analogue scale (VAS) scores in different periods, opioids consumption, length of stay and postoperative complications; (5) Study design: clinical randomized control trials (RCTs) were regarded as eligible in our study. Cochrane Hand book for Systematic Reviews of Interventions was used for assessment of the included studies and risk of bias was shown. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed. Meta-analysis was performed using Stata 11.0 software.Results:Five RCTs including 308 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = −0.080, 95% CI: −0.306 to 0.145, P = .485), 24 hours (SMD = 0.098, 95% CI: −0.127 to 0.323, P = .393), and 48 hours (SMD = −0.001, 95% CI: −0.227 to 0.225, P = .993). No significant differences were found regarding opioid consumption at 12 hours (SMD = 0.026, 95% CI: −0.224 to 0.275, P = .840), 24 hours (SMD = 0.037, 95% CI: −0.212 to 0.286, P = .771), and 48 hours (SMD = −0.016, 95% CI: −0.265 to 0.233, P = .900). In addition, no significant increase of complications was identified between groups.Conclusion:There is no significant differences of VAS scores at 12-48 hour and opioids consumption at 12-48 hour between two groups following total joint arthroplasty. No increased risk of nausea, vomiting and pruritus was observed in both groups. More high-quality large RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of FNB with FIB. The present meta-analysis exists some limitations that should be noted: (1) Only five articles were included in present meta-analysis, although all of them are recently published RCTs, the sample size are relatively small; (2) Functional outcome is an important parameter, due to the insufficiency of relevant data, we cannot perform a meta-analysis. (3) Dose and types of local anesthetics are varied, which may influence the results; (4) The duration of follow up is relatively short which leads to underestimating complications. (5) Publication bias in present meta-analysis ...

Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

“…Their study results also showed that FINB had lower opioid requirements than IVA. Another meta-analysis by Wang et al [38] included four studies and showed that FNB and FINB resulted in similar opioid requirements until 48 h postoperatively in patients undergoing total knee and hip arthroplasties. Taken together, we suggest the need for more studies to elucidate the impact of FNB on postoperative opioid requirements.…”

Ultrasound‐guided femoral nerve blocks are not superior to ultrasound‐guided fascia iliaca blocks for fractured neck of femur

“…Ultrasound guidance is a superior technique for nerve block administration and may facilitate equivalent analgesic effect in FNB and FICB. It has been advocated that FICB is easier to perform with a better safety profile than FNB, therefore, utilising ultrasound‐guided FICB may improve the delays in analgesia. Using ultrasound guidance achieved a high success rate in both FNB and FICB administered with the vast majority of participants experiencing pain reduction post‐block.…”

“…In comparison to FNB, the risk of injury to the femoral nerve and femoral vessels is lessened when performing FICB. As a result of the safety profile and relative ease of administration, there is a growing preference for the use of FICB in EDs …”

Lower extremity regional anesthesia: essentials of our current understanding

“…Although they did find greater ambulation distances with lumbar plexus catheters, unlike Marino et al ,400 they could not detect intergroup differences in terms of pain, breakthrough analgesic consumption, and patient satisfaction 401. In a recent meta-analysis (five trials; 308 patients), Wang et al 402 set out to compare fascia iliaca and femoral blocks for THA: these authors concluded that fascia iliaca and femoral blocks result in equivalent analgesia. However, their findings should be interpreted wit caution, as all pooled trials have employed the conventional infrainguinal technique for fascia iliaca blocks.…”