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Minerva Anestesiologica 2019 November;85(11):1211-8

DOI: 10.23736/S0375-9393.19.13535-3


lingua: Inglese

Systematic review and meta-analysis of single injection fascia iliaca blocks in the peri-operative management of patients with hip fractures

Fiqry FADHLILLAH 1, David CHAN 1, Paolo PELOSI 2, 3, Francesca RUBULOTTA 4

1 Department of Anesthesia, Imperial College London Institute of Clinical Sciences, London, UK; 2 Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; 3 IRCCS for Oncology and Neurosciences, San Martino Policlinic Hospital, Genoa, Italy; 4 Department of Anesthesia and Intensive Care, Imperial College London Institute of Clinical Sciences, London, UK

INTRODUCTION: The aim of the study was to determine the analgesic efficacy and safety profile of single injection fascia iliaca compartment block (FICB) performed peri-operatively for isolated hip fractures.
EVIDENCE ACQUISITION: MEDLINE, EMBASE, Cochrane and CINAHL were searched from inception to February 2018. Inclusion criteria were: English language, adult patients (>18 years old), isolated traumatic hip fracture treated with single injection FICB peri-operatively. Data were extracted into a pre-piloted form that utilized the PRISMA-P 2015 checklist. Two investigators conducted reviews independently; any ambiguity was resolved by discussion. The quality of studies was assessed using the GRADE checklist and Cochrane risk of bias tool. A random-effects model was applied. Outcomes reviewed were pain level at rest and movement, breakthrough analgesia and complications.
EVIDENCE SYNTHESIS: Out of 3757 citations, eight RCTs were included involving 645 participants. Pain was significantly reduced during movements (SMD=-1.82, 95% CI -2.26 to -1.38, P<0.00001) but not at rest (SMD=-0.68, 95% CI -1.70 to 0.35, P=0.20). FICB allowed less (breakthrough) supplemental analgesic (N.=57 vs. N.=73), however this did not reach statistical significance (P=0.19).
CONCLUSIONS: FICB is effective in controlling acute peri-operative pain in adult patients with traumatic hip fractures. The benefit is more evident during mobilization of the limb when compared to patients at rest.

KEY WORDS: Analgesia; Pain management; Fractures, bone; Joint dislocations; Spine; Pelvis

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