Professor, Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Department of Anaesthesia, MMIMSR, MM (DU), Mullana, Ambala, India.
Am J Emerg Med. 2021 Dec;50:654-660. doi: 10.1016/j.ajem.2021.09.038. Epub 2021 Sep 25.
Fascia iliaca block (FICB) has been used to reduce pain and its impact on geriatric patients with hip fractures.
We conducted this meta-analysis to investigate the analgesic efficacy of this block in comparison to standard of care (SOC) when performed by non-anesthesiologist in the emergency department.
Search on PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane database for randomized and quasi-randomized trials were performed. The primary outcome was to compare pain relief at rest at 2-4 h. The pain relief at various time intervals, reduction in opioid use, the incidence of nausea/ vomiting, delirium and length of hospital stay were the secondary outcomes studied. Trial Sequential Analysis (TSA) was performed for the primary outcome.
Eleven trials comprising 895 patients were included in the meta-analysis. Patients receiving FICB had significant better pain relief at rest at 2-4 h with mean difference of 1.59 (95% CI, 0.59-2.59, p = 0.002) with I = 96%. However, the certainty of the evidence was low and TSA showed that the sample size could not reach the requisite information size. A significant difference in pain relief at rest and on movement started within 30 min and lasted till 4 h of the block. Use of FICB was associated with a significant reduction in post-procedure parenteral opioid consumption, nausea and vomiting and length of hospital stay.
FICB is associated with significant pain relief both at rest and on movement lasting up to 4 h as well as a reduction in opioid requirement and associated nausea and vomiting in geriatric patients with hip fracture. However, the quality of evidence is low and additional trials are necessary.
髂筋膜阻滞（FICB）已被用于减轻老年髋部骨折患者的疼痛及其影响。
我们进行了这项荟萃分析，旨在研究在急诊科由非麻醉医生进行时，与标准治疗（SOC）相比，这种阻滞在缓解疼痛方面的效果。
在 PubMed、SCOPUS、EMBASE、Google Scholar 和 Cochrane 数据库中进行了随机和半随机试验的检索。主要结局是比较 2-4 小时静息时的疼痛缓解情况。研究的次要结局包括不同时间间隔的疼痛缓解、阿片类药物使用减少、恶心/呕吐、谵妄发生率和住院时间。对主要结局进行了试验序贯分析（TSA）。
共有 11 项试验纳入 895 名患者进行荟萃分析。接受 FICB 的患者在 2-4 小时静息时的疼痛缓解明显更好，平均差异为 1.59（95%置信区间，0.59-2.59，p=0.002），I=96%。然而，证据的确定性较低，TSA 表明样本量无法达到所需的信息量。阻滞开始后 30 分钟内和 4 小时内，静息和运动时的疼痛缓解均有显著差异。使用 FICB 与术后静脉使用阿片类药物的消耗、恶心和呕吐以及住院时间的减少显著相关。
FICB 可显著缓解老年髋部骨折患者的静息和运动疼痛，持续时间长达 4 小时，并可减少阿片类药物的需求以及相关的恶心和呕吐。然而，证据质量较低，需要进一步的试验。
