Table 3.

RCTs evaluating FICB in pain management in geriatric patients with hip fracture.

Study	Country	Comparison and no. of the included patients	FICB strategy	Outcome parameters	Primary conclusions
Preoperative use
Foss et al. 2007 [24]	Denmark	FICB = 24 vs IM morphine = 24	40 mL 1.0% mepivacaine	VRS (rest/movement), total morphine consumption	FICB provided better pain relief at all times and at all measurements compared to IM morphine
McRae et al.2015 [25]	Australia	FICB = 11 vs standard care (IV morphine) = 13	15–20 mL 2% lidocaine, weight-dependent	NRS, adverse events	FICB group had a greater reduction in pain than those who received standard care
Wennberg et al. 2019 [26]	Sweden	FICB = 66 vs placebo (saline) = 61 (adjunctive therapy)	30 mL 0.2% ropivacaine	VAS	Low-dose FICB improved pain management as a pain-relieving adjuvant to other analgesics
Pasquier et al. 2019 [27]	Switzerland	FICB = 15 vs placebo (saline) = 15 (adjunctive therapy)	30 mL 0.5% bupivacaine	NRS (rest/movement), total morphine consumption	Anatomic landmark-based FICB did not help reduce pain after prehospital morphine
Godoy Monzón et al. 2010 [28]	Argentina	FICB = 62 vs IV NSAIDs (Diclofenac or Ketorolac) = 92	0.3 mL/kg 0.25% bupivacaine	VAS	FICB can provide equally effective analgesia as NSAIDs for up to 8 h
Ma et al. 2018 [29]	China	CFICB = 44 vs oral drugs (tramadol and paracetamol) = 44	50 mL 0.4% ropivacaine, 5 mL/h 0.2% ropivacaine continuously	VAS (rest/movement), patients' satisfaction, side effects, length of hospital stay	Patients treated with CFICB received better analgesia both at rest and at movement compared to traditional analgesia
Newman et al. 2013 [30]	UK	FICB = 56 vs FNB = 51	20–30 mL 0.5% levobupivacaine, weight-dependent	VAS, opioid consumption	Patients treated with FNB had better pain control and less morphine requirement
Zhou et al. 2019 [31]	China	FICB = 77 vs FONB = 77	35 mL 0.4% ropivacaine	VAS (rest/exercise), requirement for analgesic drugs, postoperative complications	Both FONB and FICB were effective in acute pain control. FONB performed better in reducing pain and function recovery
Cooper et al. 2019 [32]	Australia	FICB = 52 vs FNB = 48	20 mL 0.5% levobupivacaine	NRS	FICB can provide equivalent analgesia effect as FNB for femur fracture patients
Reavley et al. 2015 [33]	UK	FICB = 88 vs “3-in-1”block = 90	2 mg/kg 0.5% bupivacaine	VAS	FICB was as effective as “3-in-1” block for immediate pain relief
Aprato et al. 2018 [34]	Italy	FICB = 70 vs IAHI = 50	40 mL 0.25% ropivacaine	NRS (rest/movement), additional analgesic drug, adverse events	IAHI provided better pain management and reduced systemic analgesia consumption compared with FICB
Wennberg et al. 2019 [35]	Sweden	FICB = 65 vs control = 60	30 mL 2 mg/mL ropivacaine	Changes of cognitive status	FICB did not affect cognitive status in this study
Application before surgical anesthesia
Yun et al. 2009 [36]	Korea	FICB = 20 vs IV alfentanil = 20	30 mL 0.375% ropivacaine	Time to achieve SA, VAS, quality of patient positioning, patient acceptance	FICB was more efficacious than IV alfentanil with better pain control during positioning and shorter time to achieve SA as well
Diakomi et al. 2014 [37]	Greece	FICB = 21 vs IV fentanyl = 20	40 mL 0.5% ropivacaine	Time needed and quality of position, NRS, postoperative analgesia, morphine consumption, patient satisfaction	Patients who received FICB showed significantly lower pain score, shorter spinal performance time, and better quality of position
Madabushi et al. 2016 [38]	India	FICB = 30 vs IV fentanyl = 30	30 mL 0.375% ropivacaine	VAS, sitting angle, positioning quality, time to perform SA, postoperative analgesic requirement	Patients who received FICB needed less time for SA and had better quality of positioning accompanied by superior analgesia
Kacha et al. 2018 [39]	India	FICB = 50 vs placebo (normal saline) = 50	30 mL 0.25% ropivacaine	VAS, time of positioning SA, total duration of analgesia	FICB effectively provided analgesia during positioning for SA and significantly extended the total duration of analgesia
Postoperative use
Temelkovska-Stevanovska et al. 2014 [40]	Macedonia	FICB = 30 vs FNB = 30	40 mL 0.25% bupivacaine	VDS (rest/movement), additional analgesia, and duration for the first time, side effects	FNB provided superior postoperative pain relief versus FICB, and lower amount of supplemental analgesia
Deniz et al. 2014 [41]	Turkey	FICB = 20 vs “3-in-1” block = 20 vs control = 20	30 mL 0.25% bupivacaine	VAS, opioid consumption, adverse effects, and cortisol and ACTH levels	Both FICB and “3-in-1” block can bring superior analgesia and reduction in opioid consumption. The two blocks also showed a suppression of stress hormones
Bang et al. 2016 [42]	Korea	FICB = 11 vs. Non-FICB = 11	40 mL 0.2% ropivacaine	Postoperative VAS scores, opioid consumption, and adverse events	The FICB had a significant opioid-sparing effect in the first 24 hours after hemiarthroplasty
Mostafa et al. 2018 [43]	Egypt	FICA = 30 vs. IV fentanyl = 30	35 mL 0.125% levobupivacaine + PC-FICA∗	Postoperative VAS scores, additional analgesia requirement, and total additional analgesia assumption	PC-FICA provided a better quality of analgesia and decreased postoperative rescue analgesic requirement without increased side effects compared to PCA IV fentanyl
Yamamoto et al. 2019 [44]	Japan	FICB = 25 vs IV acetaminophen = 28	40 mL 0.25% levobupivacaine	VAS (rest/movement), total number of rescue analgesics required, incidence of delirium	Patients treated with FICB received better pain control compared to IV NSAIDs without increasing the complication rate
Thompson et al. 2020 [45]	America	FICB = 23 vs control = 24	30 mL 0.25% ropivacaine	Pain medication consumption, functional recovery, patient satisfaction	FICB significantly decreased postoperative consumption of morphine for breakthrough pain while increasing patient satisfaction
Schulte et al. 2020 [46]	USA	FICB = 57 vs control = 40	45 to 60 mL 0.375% ropivacaine	VAS, MME, postoperative ambulatory distance	A single perioperative FIB for patients with hip fractures undergoing surgery may decrease opioid consumption and increase the likelihood that a patient is discharged home
Diakomi et al. 2020 [47]	Greece	FICB = 91 vs sham FICB = 91	40 mL 0.5% ropivacaine	Incidence, intensity, and severity of CPSP at 3 and 6 months after hip fracture surgery	FICB in the perioperative setting may reduce the incidence, intensity, and severity of CPSP at 3 and 6 months after hip fracture surgery, providing safe and effective postoperative analgesia
Other benefits of FICB
Mouzopoulos et al. 2009 [48]	Greece	FICB = 102 vs placebo (water for injection) = 105	0.25 mg dose of 0.3 mL/kg bupivacaine	Perioperative delirium, mean duration of delirium	Severity and incidence of delirium were significantly lower in intermediate-risk patients treated with FICB, along with shorter mean duration of delirium
Nie et al. 2015 [49]	China	CFICB = 51 vs PCIA (IV fentanyl) = 53	20–30 mL 0.5% ropivacaine, 0.1 mL/kg/h 0.25% ropivacaine continuously	Postoperative pain and complications (delirium, nausea and vomiting, and pruritus)	FICB showed a stronger effect on reducing postoperative nausea and vomiting, and pruritus, but with a higher incidence of developing delirium
Hao et al. 2019 [50]	China	CFICB = 44 vs placebo (normal saline) = 46	30 mL 0.45% ropivacaine, 6 mL/h 0.25% ropivacaine continuously	Postoperative delirium, change in preoperative and postoperative pain scores, opioid consumption	The incidence of post-op delirium was lower for patients who received CFICB

RCTs: randomized controlled trials; FICB: fascia iliaca compartment block; VRS: verbal rating scale; IM: intramuscular; IV: intravenous; NRS: numerical rating scale; VAS: visual analogue scale; NSAIDs: non-steroidal anti-inflammatory drugs; CFICB: continuous fascia iliaca compartment block; FNB: femoral nerve block; FONB: femoral obturator nerve block; IAHI: intra-articular hip injection; SA: spinal anesthesia; VDS: verbal descriptive scale; ACTH: adrenocorticotropic hormone; PCIA: patient-controlled intravenous analgesia; FICA: fascia iliaca compartment analgesia; PC-FICA:: patient-controlled fascia iliaca compartment analgesia; MME: morphine milligram equivalents; CPSP: chronic postsurgical pain. ^∗Protocol: a continuous basal infusion of 4 mL/h levobupivacaine 0.125% and demand boluses of 2 ml with a lockout interval of 15 min.