Fascia iliaca compartment block versus intravenous analgesic for positioning of femur fracture patients before a spinal block: A PRISMA-compliant meta-analysis

Yuan-Pin Hsu, Chin-Wang Hsu, Chyi-Huey Bai, Sheng-Wei Cheng, Chiehfeng Chen, Yuan-Pin Hsu, Chin-Wang Hsu, Chyi-Huey Bai, Sheng-Wei Cheng, Chiehfeng Chen

Abstract

Background: Fascia iliaca compartment block (FICB) provides an analgesic option for positioning before spinal anesthesia in patients suffering from a femur fracture. The evidence supporting FICB is still not well established. The aim of our study is to assess the efficacy and safety of FICB comparing with intravenous analgesic (IVA) on the quality for positioning before spinal anesthesia in participants with a femur fracture.

Methods: PubMed, Embase, and Scopus databases were interrogated from their inceptions to September 2017. We included randomized controlled studies reported as full text, those published as abstracts only and unpublished data, if available. Data were independently extracted by 2 reviewers and synthesized using a random-effects model.

Main results: Three studies comprising 141 participants showed that FICB compared to IVA led to a significant between-group standard mean differences in quality during positioning within 30 minutes before spinal anesthesia (standardized mean difference (SMD) -2.02, 95% confidence interval (CI): -2.43 to -1.61, I = 0%) and time for spinal anesthesia (pooled mean difference (PMD) -2.86 minutes, 95% CI -3.70 to -2.01, I = 0%). Two studies with 101 participants suggested that FICB is superior to IVA on opioid requirements 24 hours postoperatively (pooled odds ratio (POR): 0.11, 95% CI: 0.03 to 0.35, I = 13%). There were no significant differences in complications or hemodynamic effects CONCLUSIONS:: Comparing with IVA, FICB can provide significantly better quality during positioning of femur fracture patients for a spinal block and a shorter time for spinal anesthesia. FICB is safe method.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the search process and search results.
Figure 2
Figure 2
Methodological quality: (A) Risk of bias summary of the randomized controlled trials; (B) Risk of bias graph of the randomized controlled trials.
Figure 3
Figure 3
Meta-analysis for primary outcomes. (A) Forest plot of positioning before spinal anesthesia (within 30 minutes), (B) forest plot of time for spinal anesthesia (minutes).
Figure 4
Figure 4
Meta-analysis for secondary outcomes. (A) Forest plot of anesthesiologists’ satisfaction with the quality for spinal anesthesia, (B) forest plot of time to first opioid requirement (hours), (C) forest plot of opioid requirement at 24 hours postoperatively, (D) forest plot of participant acceptance.

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Source: PubMed

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