1. Anaesthetic techniques.
| Study | Purpose of blockade | Time of block placement | Surgical anaesthesia | Block technique | Comparison | Supplemental analgesia for both groups |
| Albrecht 2014 | Preoperative analgesia | In the emergency department | No information | Fascia iliaca compartment block Landmarks Single injection Bupivacaine 0.5% with epinephrine 1:200,000 30 mL Operator: trained emergency physicians |
Sham block with normal saline | Acetaminophen Morphine |
| Altermatt 2013 | Preoperative, intraoperative, and postoperative analgesia | Preoperatively, probably in the emergency department | Spinal anaesthesia | Psoas compartment block Nerve stimulator (quadriceps contraction at 0.5 mA, 1 Hz, 0.1 millisecond) Continuous infusion Bupivacaine 0.1% 20 mL followed by patient‐controlled analgesia: basal rate 8 mL/hour, bolus 5 mL, lock‐out time 30 minutes for 72 hours Operator: no information |
No nerve block IV PCA with Morphine |
Acetaminophen Ketorolac |
| Antonopoulou 2006 | Postoperative analgesia | After recovery of anaesthesia | Spinal anaesthesia | Femoral nerve block Nerve stimulator Continuous infusion Levobupivacaine 0.25% 18 mL followed by levobupivacaine 0.125% at 3 to 4 mL/hour for 24 hours after surgery Operator: no information |
No nerve block | Acetaminophen Pethidine |
| Bang 2016 | Postoperative analgesia | After surgery and after confirmation of patient’s mental status to be alert, able to communicate, and obey commands | Spinal anaesthesia | Fascia iliaca compartment block Ultrasound‐guided Single injection Ropivacaine 0.2% 40 mL Operator: no information |
No nerve block | Ketorolac Celecoxib IV PCA with Fentanyl Tramadol |
| Brownbridge 2018 | Preoperative, intraoperative, and postoperative analgesia | Preoperatively, after patients had been assigned to a bed on the ward | Spinal (53% for intervention group and 40% for comparator group) or general anaesthesia | Fascia iliaca compartment block Landmarks Continuous infusion Ropivacaine 0.125% 40 mL followed by ropivacaine 0.2% 10 mL/hour until surgery. In the operating room, catheters were re‐bolused with 40 mL 0.125% ropivacaine, then removed Operator: anaesthesiology department |
No nerve block | Acetaminophen NSAIDs Opioids |
| Chudinov 1999 | Preoperative, intraoperative, and postoperative analgesia Surgery for some participants |
Preoperatively, within 6 hours after admission to the orthopaedic ward | Intervention: psoas block alone (3/20) with sciatic block (5/20), spinal (11/20) or general anaesthesia (1/20) Comparator: neuraxial block (19/20) or general anaesthesia (1/20) |
Psoas compartment block Landmarks and loss of resistance to air, lateral decubitus with operated side up (1 epidural spread) Continuous infusion: started preoperatively (16 to 48 hours) and kept for 72 hours after surgery Test dose with 3 mL of 0.5% bupivacaine with epinephrine 5 mcg/mL followed by bupivacaine 0.25% with epinephrine 5 mcg/mL 0.8 mL/kg over 8 minutes plus 1 to 2 mg/kg routinely every 8 hours and before surgery (unless already received < 3 hours) Operator: anaesthesiologists |
No nerve block IM Meperidine Diclofenac |
IM Meperidine |
| Coad 1991 | Postoperative analgesia | At completion of surgery before awakening from general anaesthesia | General anaesthesia | 1) Lateral femoral cutaneous nerve block
2) 3‐in‐1 femoral nerve block Landmarks Single injection 1) Bupivacaine 0.5% with epinephrine 5 mcg/mL 15 mL 2) Bupivacaine 0.5% with epinephrine 5 mcg/mL 15 mL Operator: anesthesiology department |
No nerve block | Pethidine |
| Cuvillon 2007 | Postoperative analgesia | After ending of effects of spinal blockade | Spinal anaesthesia | Femoral nerve block Nerve stimulator (quadriceps for patella ascension with 0.3 to 0.5 mA at 0.1 ms and catheter 10 to 15 cm passed over the needle tip) Continuous infusion Lidocaine 1.5% plus epinephrine 30 mL of lidocaine 1.5% followed by ropivacaine 0.2% at 10 mL/hour for 48 hours Operator: anesthesiology department |
No nerve block IV Paracetamol for half of participants in the comparator group |
1 dose of paracetamol in the emergency department Morphine |
| De La Tabla 2010 | Preoperative, intraoperative, and postoperative analgesia | Upon hospital arrival | No information | Femoral nerve block Dual technique: ultrasound‐guided plus nerve stimulator Continuous infusion Ropivacaine 0.2% 15 mL followed by ropivacaine 0.2% at 5 mL/hour basal rate plus boluses of 10 mL every 30 minutes Operator: no information |
No nerve block IV Metamizole |
IV Tramadol |
| Deniz 2014 | Intraoperative and postoperative analgesia | In the operating room, before induction of general anaesthesia | General anaesthesia | 1) Fascia iliaca compartment block
2) 3‐in‐1 femoral nerve block 1) Ultrasound‐guided 2) Dual technique: ultrasound‐guided plus nerve stimulator (quadriceps contraction at 0.5 mA) Single injection 1) Bupivacaine 0.25% 30 mL 2) Bupivacaine 0.25% 30 mL Operator: anesthesiology department |
No nerve block | Tenoxicam IV PCA with Tramadol |
| Diakomi 2014 | Spinal positioning, intraoperative and postoperative analgesia | Before positioning for spinal anaesthesia | Spinal anaesthesia | Fascia iliaca compartment block Landmarks Single injection Ropivacaine 0.5% 40 mL Operator: anesthesiology department |
No nerve block IV Fentanyl for positioning for spinal block |
IV PCA with Morphine |
| Domac 2015 | Spinal positioning, intraoperative and postoperative analgesia | In the regional anaesthetic technique room, before spinal anaesthesia | Spinal anaesthesia | Fascia iliaca compartment block Landmarks Single injection Bupivacaine 0.5% 15 mL and lidocaine 2% 15 mL Operator: anesthesiology department |
No nerve block | IV PCA with Morphine Tramadol |
| Fletcher 2003 | Preoperative analgesia | In the emergency department, after radiographic confirmation | No information | 3‐in‐1 femoral nerve block Paraesthesia Single injection Bupivacaine 0.5% 20 mL Operator: trained emergency physicians |
No nerve block | IV Morphine |
| Foss 2005a | Preoperative analgesia | Upon arrival in the emergency department | No information | Fascia iliaca compartment block Landmarks Single injection Mepivacaine 1% with epinephrine 5 mcg/mL 40 mL Operator: junior anaesthesiologists with less than 2 years of training |
Sham block with 0.9% saline plus IM Morphine |
IV Morphine Epidural analgesia after 3‐hour study period |
| Gille 2006 | Preoperative, intraoperative. and postoperative analgesia | Upon arrival in the emergency department | Intervention: spinal anaesthesia for 37/50 and general anaesthesia for 13/50 Comparator: spinal anaesthesia for 38/50 and general anaesthesia for 12/50 |
Femoral nerve block Nerve stimulator (0.5 mA and 0.1 millisecond) Continuous infusion (non‐stimulating catheters advanced about 10 cm past the needle tip) Prilocaine 1% 40 mL followed 2 hours later by ropivacaine 0.2% 30 mL, repeated every 6 hours (up to 40 mL; N = 5) and at intervals (up to every 4 hours; N = 8) or both (N = 6), adjusted on pain scores Operator: anaesthesiology department |
No nerve block IV Metamizole Oral Tilidine and Naloxone |
Ibuprofen Tilidine |
| Godoy Monzon 2010 | Preoperative analgesia | In the emergency department, after confirmation of diagnosis | No information | Fascia iliaca compartment block Landmarks Single injection Bupivacaine 0.25% 0.3 mL/kg Operator: physicians (first study author is an orthopaedic surgeon) |
Sham block with saline and IV NSAIDs | NSAIDs Opioids |
| Graham 2008 | Preoperative analgesia | In the emergency department | No information | Femoral (3‐in‐1) nerve block Single injection Nerve stimulator Bupivacaine 0.5% 30 mL (not exceeding 3 mg/kg) Operator: specialist emergency physician or higher trainee resident, post intermediate examination level |
No nerve block IV Morphine |
IV Morphine Dihydrocodeine Diclofenac Paracetamol |
| Gürtan Bölükbasi 2013 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | No information | Fascia iliaca compartment block Single injection Ultrasound‐guided Levobupivacaine 0.375% 30 mL Operator: anesthesiology department |
No nerve block IV Remifentanil |
Additional analgesia |
| Haddad 1995 | Preoperative analgesia | In the emergency department | No information | Femoral nerve block Single injection Bupivacaine 0.25%.0.3 mL/kg Paraesthesia technique with a short bevel needle Operator: 1 orthopaedic registrar |
No nerve block | Co‐dydramol Voltarol Pethidine |
| Henderson 2008 | Preoperative analgesia | In the emergency department | No information | Femoral nerve block Nerve stimulator Single injection Bupivacaine 0.5% Operator: trained emergency physicians |
No nerve block | Opioids |
| Hogg 2009 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | Spinal anaesthesia | Fascia iliaca compartment block No information on localizing technique Single injection Lidocaine 1% 2 mg/kg Operator: anaesthesiology department |
No nerve block IV Ketamine 0.2 mg/kg IV Midazolam 0.025 mg/kg |
Ketamine |
| Hood 1991 | Intraoperative and postoperative analgesia | Before induction of general anaesthesia | General anaesthesia | 1) Femoral "3‐in‐1" nerve block
2) Infiltration above the iliac crest 1) Nerve stimulator (quadriceps contraction with < 1 mA) 2) Landmarks Single injection 1) Prilocaine 0.75% 35 mL 2) Prilocaine 0.75% 8 mL Operator: anaesthesiology department |
No nerve block | Papaveratum |
| Jadon 2014 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | Spinal anaesthesia | Femoral nerve block Nerve stimulator (quadriceps contraction with 0.3 to 0.5 mA) Single injection Lidocaine 1.5% (2% diluted with distilled water) with epinephrine 5 mcg/mL 20 mL Operator: anaesthesiology department |
No nerve block IV Fentanyl |
IV Fentanyl |
| Jang 2018 | Preoperative analgesia | In the emergency department, 48 hours before surgery | No information | Femoral nerve block Single injection Ultrasound‐guided (in‐plane) Bupivacaine 0.5% 0.3 mL/kg (maximum 20 mL) Operator: 1 physician experienced in administering ultrasound‐guided femoral nerve blocks |
Sham block with saline | IV Tramadol |
| Jones 1985 | Postoperative analgesia | At completion of surgery, while still under general anaesthesia | General anaesthesia | Lateral femoral cutaneous nerve block Single injection Landmarks Bupivacaine 0.5% with epinephrine 5 mcg/mL 15 mL Operator: anaesthesiology department |
No nerve block | IM Pethidine |
| Kullenberg 2004 | Preoperative analgesia | As soon as the diagnosis of hip fracture was radiologically confirmed | No information | Femoral nerve block Nerve stimulator Single injection Ropivacaine 0.75% 30 mL. Operator: 1 orthopaedic surgeon |
No nerve block | Paracetamol Tramadol Ketobemidon |
| Landsting 2008 | Preoperative analgesia | Within 1 hour of hospital admission | No information | Fascia iliaca compartment block Landmarks Single injection Ropivacaine 0.2% 30 mL Operator: orthopaedic surgeons |
Sham block with saline | IV Morphine Paracetamol |
| Liebmann 2012 | Preoperative analgesia | In the emergency department | No information | 3‐in‐1 femoral nerve block Ultrasound‐guided (in‐plane) Single injection Bupivacaine 0.5% 25 mL Operator: emergency physicians experienced with the technique |
Sham block with saline | Morphine |
| Luger 2012 | Preoperative, intraoperative, and postoperative analgesia | In the emergency department | Spinal anaesthesia | Femoral "3‐in‐1" nerve block Ultrasound‐guided Continuous infusion (catheters inserted ≥ 12 to 15 cm past the needle tip) Bupivacaine 0.25% 30 mL (additional 10 mL if required for adequate sensory blockade) followed by bupivacaine 0.125% at 6 mL/hour Operator: anesthesiology department |
No nerve block | Piritramide Paracetamol |
| Ma 2018a | Preoperative analgesia | After hospital admission | No information | Fascia iliaca compartment block Ultrasound‐guided (in‐plane) Continuous infusion (catheters 5 to 10 cm beyond the tip of the needle) Ropivacaine 0.4% 30 mL followed by ropivacaine 0.2% at 5 mL/hour plus 5 mL for breakthrough pain until surgery (mean 3.5 days). Catheters removed on the morning of surgery Operator: 1 anaesthesiologist experienced in ultrasound‐guided nerve block |
No nerve block | Tramadol Acetaminophen Pethidine |
| Madabushi 2016 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | Spinal anaesthesia | Fascia iliaca compartment block Landmarks Single injection Ropivacaine 0.375% 30 mL Operator: anaesthesiologists |
No nerve block IV Fentanyl |
Paracetamol Tramadol Diclofenac |
| Morrison 2008 | Preoperative analgesia, intraoperative and postoperative analgesia | In the emergency department for femoral nerve block and within 24 hours of femoral block for continuous fascia iliaca block | Regional anaesthesia for 62.1% | 1) Femoral nerve block
2) Fascia iliaca compartment block (within 24 hours of #1) Ultrasound‐guided (out‐of‐plane for insertion, but advancement visualized) 1) Single injection Bupivacaine 0.5% 20 mL 2) Continuous infusion Ropivacaine 0.2% 15 mL followed by 5 mL/hour for 72 hours after surgery Operators: 1) Trained emergency physicians 2) Anaesthesiologists (mobile peripheral nerve block service) |
No nerve block | Opioids Acetaminophen |
| Mosaffa 2005 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | Spinal anaesthesia | Fascia iliaca block with 20 mL of 1.5% lidocaine No information for localizing technique Single injection Lidocaine 1.5% 20 mL Operator: anaesthesiology department |
No nerve block IV Fentanyl |
No information |
| Mouzopoulos 2009 | Preoperative and postoperative analgesia | Started upon admission to the orthopaedic ward | Epidural anaesthesia | Fascia iliaca compartment blocks daily (from admission until surgery, restarted at 24 hours after surgery until discharge, stopped earlier (before or after surgery) if delirium occurred) Landmarks Bupivacaine 0.3 mL/kg (0.25%?) Operator: orthopaedic surgeons |
Sham blocks with water | IV Paracetamol Pethidine |
| Murgue 2006 | Preoperative analgesia | In the emergency department | No information | Femoral nerve block Nerve stimulator (quadriceps contraction with patellar ascension) Single injection Mepivacaine 20 mL Operator: unclear, published by emergency physicians |
No nerve block IV Morphine or IV Paracetamol and Ketoprofen |
Nitrous oxide |
| Nie 2015 | Postoperative analgesia | After closure of the surgical wound | General anaesthesia | Fascia iliaca block Landmarks Continuous infusion (catheter inserted ≥ 10 cm cranially) Ropivacaine 0.5% according to body weight (20 mL if weight < 50 kg, 25 mL if weight 50 kg to 70 kg, 30 mL if weight > 70 kg) followed by ropivacaine 0.25% at 0.1 mL/kg/hour for 48 hours Operator: no information, probably anaesthesiology department |
No nerve block IV PCA with Fentanyl |
Acetaminophen Dihydrocodeine Morphine |
| Ranjit 2016 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | Spinal anaesthesia | Femoral nerve block Dual technique: nerve stimulator plus in‐plane ultrasound guidance Single injection Lidocaine 2% 20 mL Operator: anaesthesiology department |
No nerve block IV Fentanyl |
IV Fentanyl |
| Segado Jimenez 2009 | Postoperative analgesia | In post‐anaesthesia care unit after full recuperation of motor blockade from the spinal block | Spinal anaesthesia | 1) Lateral femoral cutaneous nerve block
2) Obturator nerve block Landmarks Single injections 1) Bupivacaine 0.5% with vasoconstrictor 5 mL 2) Bupivacaine 0.5% with vasoconstrictor 15 mL Operator: anaesthesiology department |
No nerve block | IV Metamizole Dexketoprofen trometamol Tramadol Morphine |
| Spansberg 1996 | Postoperative analgesia | Catheters inserted before spinal anaesthesia Administration of local anaesthetics started after surgery |
Spinal anaesthesia | Femoral nerve block Nerve stimulator Continuous infusion (non‐stimulating catheter advanced 8 to 15 cm past needle tip) Bupivacaine 0.5% 0.4 mL/kg followed by bupivacaine 0.25% at 0.14 mL/kg/hour for 16 hours after surgery Operator: anaesthesiology department |
Sham block with saline | Morphine Acetylsalicylic acid |
| Szucs 2010 | Preoperative, intraoperative, and postoperative analgesia | Catheters inserted in the emergency department Administration of local anaesthetics started during catheter installation |
Spinal anaesthesia | Femoral nerve block Nerve stimulator (quadriceps contraction resulting in patellar movement with 0.4 mA and 0.1 millisecond) Continuous infusion (non‐stimulating catheter, space dilated with 10 mL of lidocaine 2%, catheter advanced cephalad 3 cm past the needle tip) Bupivacaine 0.5% 10 mL followed by 0.25% bupivacaine at 4 mL/hour for 72 hours Bolus of 2% lidocaine 10 mL 15 minutes before positioning for spinal anaesthesia Operator: anaesthesiology department |
No nerve block | Paracetamol Morphine |
| Thompson 2019 | Intraoperative and postoperative analgesia | Immediately before induction of anaesthesia | General or spinal anaesthesia (38%) | Fascia iliaca compartment block Ultrasound‐guided Single injection Ropivacaine 0.25% 30 mL Operator: a board‐certified anaesthesiologist |
No nerve block | Acetaminophen Tramadol Opioids |
| Tuncer 2003 | Postoperative analgesia | After surgery and reversal of neuromuscular blockade | General anaesthesia | Femoral (3‐in‐1) nerve block Nerve stimulator (quadriceps contraction with patellar ascension with < 1 mA) Continuous infusion (non‐stimulating catheter advanced 4 to 5 cm past the needle tip) Lidocaine 2% with epinephrine 5 mcg/mL 30 mL followed by bupivacaine 0.125% patient‐controlled analgesia: basal rate 4 mL/hour, boluses 3 mL, lockout time 20 minutes Operator: probably anaesthesiology department |
No nerve block IV PCA with Morphine |
Tenoxicam |
| Unneby 2017 | Preoperative analgesia | Before surgery, as soon as possible after admission to the orthopaedic ward | No information | Femoral nerve block Nerve stimulator (quadriceps contraction) Single injection Levobupivacaine 0.25% 20 to 40 mL In case of delayed surgery or if otherwise necessary, participants could receive 1 additional block Operator: 36 anaesthesiologists with various training |
No nerve block | Opioids |
| Uysal 2018 | Preoperative analgesia | In the emergency department | Spinal anaesthesia | Femoral nerve block Dual technique: ultrasound‐guided (in‐plane) and nerve stimulator (quadriceps contraction) Repeated doses every 8 hours through a catheter Bupivacaine 0.25% 10 mL | No nerve block IV Paracetamol |
IV Tramadol Epidural analgesia after surgery |
| Wang 2015 | Preoperative, intraoperative, and postoperative analgesia | Upon admission, after radiographic confirmation of the diagnosis | Combined spinal‐epidural anaesthesia | Fascia iliaca compartment block Ultrasound‐guided (out‐of‐plane for needle insertion and in‐plane for solution diffusion, injected cephalad) Continuous infusion (catheter inserted 5 to 10 cm past the needle tip) Ropivacaine 0.4% 50 mL followed by ropivacaine 0.2% at 5 mL/hour (plus 5 mL top‐up doses) Operator: anaesthesiologist with experience in ultrasound‑guided nerve block |
Sham block with saline Paracetamol Tramadol |
IVPCA with Sufentanil after surgery |
| White 1980 | Intraoperative and postoperative analgesia | After induction of anaesthesia, before surgery | General anaesthesia | Psoas compartment block Landmarks Single injection Mepivacaine 2% 30 mL Operator: anaesthesiology department |
No nerve block | Usual surgical care |
| Yamamoto 2016 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | Spinal anaesthesia | Fascia iliaca compartment block Ultrasound‐guided Single injection Levobupivacaine 0.25% 40 mL Operator: an orthopaedic surgeon with extensive experience in this block procedure |
No nerve block IV Acetaminophen |
Diclofenac Rescue analgesics |
| Yang 2016 | Intraoperative and postoperative analgesia | Catheter insertion and local anaesthetic administration started before induction of anaesthesia | General anaesthesia | Fascia iliaca compartment block Ultrasound‐guided Continuous infusion Ropivacaine 0.33% 30 mL followed by 0.15% ropivacaine at 2 mL/hour plus a bolus of 30 mL 0.15% ropivacaine every 24 hours for 72 hours after surgery Operator: anaesthesiology department |
No nerve block IV PCA with Sufentanil |
Rescue analgesics |
| Yun 2009 | Spinal positioning, intraoperative and postoperative analgesia | Before spinal anaesthesia | Spinal anaesthesia | Fascia iliaca compartment block Landmarks Single injection Ropivacaine 0.375% 30 mL Operator: 1 experienced anaesthesiologist |
No nerve block IV Alfentanil |
IV Alfentanil for spinal block Pethidine before spinal block and after surgery |
G: gram.
h: hour.
IM: intramuscular.
IV: inteavenous.
mA: milliAmpere.
mcg/mL: microgram/millilitre.
mg/kg: milligram/kilogram.
MHz: megahertz.
mL: millilitre.
msec: millisecond.
n: number.
NSAIDs: non‐steroidal anti‐inflammatory drugs.
PCA: patient‐controlled analgesia.
SC: subcutaneous.