Introduction

Pain management modalities after proximal femoral fracture are variable and have been studied extensively. Regional anesthesia, specifically femoral nerve (FNB) and fascia iliaca compartment blocks (FICB), can be used to provide analgesia preoperatively.

Methods

Systematic searches of all related literature were conducted in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Randomized controlled trials (RCTs) of proximal femoral fractures were included. The pain scores at different time points, opioid requirement in 24 h, mean arterial pressure, time for spinal anesthesia, patient satisfaction, and incidence of side effects between the 2 groups were extracted throughout the study.

Results

Fifteen RCTs including 1240 patients met the inclusion criteria. The present meta-analysis indicated that compared with FNB, FICB could decrease the visual analog scale (VAS) scores at 4 h after surgery (P < .05). The incidence of side effects (nausea, vomiting, and sedation) was lower in the FNB group (P < .05). Compared to the FICB, no significant difference was found at any other observed time point. Additionally, no difference was found in opioid requirement at 24 h, mean arterial pressure, time for spinal anesthesia, or patient satisfaction (P > .05).

Conclusions

FICB demonstrates a reduction in VAS score at 4 while FNB decreases the risk of several adverse events. More high-quality RCTs are necessary for proper comparison of the efficacy and safety of FNB and FICB.

中文翻译：

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股神经阻滞与髂筋膜阻滞治疗老年股骨近端骨折的比较：Meta分析

介绍

股骨近端骨折后的疼痛管理方式多种多样，并且已被广泛研究。区域麻醉，特别是股神经 (FNB) 和髂筋膜室阻滞 (FICB)，可用于术前镇痛。

方法

在 Medline、Embase 和 Cochrane Central Register of Controlled Trials 数据库中对所有相关文献进行了系统检索。包括股骨近端骨折的随机对照试验（RCT）。在整个研究过程中提取了2组不同时间点的疼痛评分、24小时阿片类药物需求量、平均动脉压、腰麻时间、患者满意度和副作用发生率。

结果

包括 1240 名患者在内的 15 项 RCT 符合纳入标准。目前的荟萃分析表明，与 FNB 相比，FICB 可降低术后 4 小时的视觉模拟评分（VAS）评分（P < .05）。FNB 组的副作用（恶心、呕吐和镇静）发生率较低（P < .05）。与 FICB 相比，在任何其他观察到的时间点均未发现显着差异。此外，在 24 小时阿片类药物需求量、平均动脉压、脊髓麻醉时间或患者满意度方面没有发现差异(P > .05)。

结论

FICB 显示 VAS 评分降低为 4，而 FNB 降低了几种不良事件的风险。为了正确比较 FNB 和 FICB 的疗效和安全性，需要更多高质量的 RCT。