Wan Hao-Yang, Li Su-Yi, Ji Wei, Yu Bin, Jiang Nan
Division of Orthopaedics & Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Department of Medical Quality Management, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Pain Res Manag. 2020 Nov 25;2020:8503963. doi: 10.1155/2020/8503963. eCollection 2020.
With continuous increase of the aging population, the number of geriatric patients with fragility hip fractures is rising sharply, and timely surgery remains the mainstay of treatment. However, adequate and effective pain control is the precondition of satisfactory efficacy. This systematic review aimed to summarize the use of fascia iliaca compartment block (FICB) as an analgesic strategy for perioperative pain management in geriatric patients with hip fractures.
PubMed and Embase databases were searched for English published randomized controlled trials (RCTs) reporting application of FICB for pain control of the older adults with hip fractures between January 1, 2000, and May 31, 2020. The modified Jadad scale was used to evaluate quality of the RCTs included. Primary outcomes of the eligible RCTs were presented and discussed.
A total of 27 RCTs with 2478 cases were included finally. The present outcomes suggested, after admission or in the emergency department (ED), FICB can provide patients with equal or even better pain relief compared with the conventional analgesia methods, which can also reduce additional analgesic consumptions. While, before positioning for spinal anesthesia (SA), FICB is able to offer superior pain control, facilitating SA performance, after surgery FICB can effectively alleviate pain with decreased use of additional analgesics, promoting earlier mobilization and preventing complications.
FICB is a safe, reliable, and easy-to-conduct technique, which is able to provide adequate pain relief during perioperative management of geriatric patients with hip fractures.
随着老龄化人口的持续增加，老年脆性髋部骨折患者数量急剧上升，及时手术仍是主要治疗手段。然而，充分有效的疼痛控制是取得满意疗效的前提。本系统评价旨在总结髂筋膜间隙阻滞（FICB）作为老年髋部骨折患者围手术期疼痛管理镇痛策略的应用情况。
检索PubMed和Embase数据库，查找2000年1月1日至2020年5月31日期间发表的英文随机对照试验（RCT），这些试验报告了FICB在老年髋部骨折患者疼痛控制中的应用。采用改良的Jadad量表评估纳入的RCT的质量。对符合条件的RCT的主要结局进行了呈现和讨论。
最终纳入27项RCT，共2478例患者。目前的结果表明，入院后或在急诊科（ED），与传统镇痛方法相比，FICB能为患者提供同等甚至更好的疼痛缓解，还能减少额外镇痛药物的消耗。同时，在腰麻（SA）定位前，FICB能提供更好的疼痛控制，便于SA操作，术后FICB能有效缓解疼痛，减少额外镇痛药物的使用，促进早期活动并预防并发症。
FICB是一种安全、可靠且易于实施的技术，能够在老年髋部骨折患者围手术期管理中提供充分的疼痛缓解。
