Fascia iliaca block should not be used as a routine form of pain control for hip arthroscopy, according to a new study.
Fascia Iliaca Block Not Advised for Pain Control After Hip Surgery
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In the study, “Fascia Iliaca Block for Postoperative Pain Control After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials,” published March 12, 2021 in The American Journal of Sports Medicine, researchers conducted a systematic review on the efficacy of fascia iliaca block compared with other analgesic modalities after hip arthroscopy.
The research team collected data on postoperative pain scores and analgesic consumption. Only randomized controlled trials up to April 2020 were included.
Overall, five studies met the inclusion criteria for the systematic review. Together they included 157 patients undergoing hip arthroscopy with fascia iliaca block (mean age, 38.3 years; 44.6% men) and 159 patients in the following comparison groups: lumbar plexus block, intra-articular ropivacaine, local anesthesia infiltration, saline placebo, and a no-block control group (overall mean age, 36.2 years; 36.5% men).
The researchers found no significant differences in pain scores in the post anesthesia care unit between the fascia iliaca block and lumbar plexus block (34. vs. 2.9; p = .054), intra-articular ropivacaine (7.7 vs. 7.9; p = .72), control group (no fascia iliaca block: 4.1 vs. 3.8; p = .76); or saline placebo (difference, -0.2 [95% CI, -1.1 to 0.7]).
One study reported significantly higher pain scores at 1 hour post operation in the fascia iliaca block group compared with the local anesthetic infiltration group (5.5 vs. 3.4; p = .02). Another study found that the fascia iliaca block group consumed more pain medicine than the lumbar plexus group (20.8 vs. 17.0; p = .02).
Overall, there were no significant differences in total post anesthesia care unit analgesic consumption between fascia iliaca block and other analgesic modalities.
“In patients undergoing hip arthroscopy, the fascia iliaca block does not appear to demonstrate superiority to other forms of analgesics in the immediate postoperative period. Therefore, it is not recommended as a routine form of pain control for these procedures,” the researchers wrote.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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