The effect of fascia iliaca compartment block on postoperative delirium in elder adults undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

Objective

This meta-analysis aimed to evaluate whether fascia iliaca compartment block (FIB) could reduce the incidence of postoperative delirium (POD) in elderly patients undergoing hip surgery.

Methods

This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023490399). The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) till November 15, 2023. Review Manger 5.4 was used to analyze the data.

Results

A total of 10 RCTs with 930 elderly patients were included in this meta-analysis. This meta-analysis indicated that FIB could reduce the incidence of POD in elderly patients undergoing hip surgery without preoperative cognitive impairment (OR:0.46; 95%CI[0.22, 0.96], P = 0.04, I² = 0%). Subgroup analysis of the incidence of POD showed that elderly patients who received FIB treatment before entering the operating room had a lower risk of developing POD(OR:0.48; 95%CI[0.30, 0.76], P = 0.002, I² = 0%), and FIB could reduce the occurrence of POD in patients undergoing intravertebral anesthesia instead of general anesthesia (OR:0.37; 95%CI[0.20, 0.66], P﹤0.01, I² = 0%). Moreover, FIB could reduce the MMSE score on the first day after surgery (SMD:1.07; 95%CI[0.15, 1.99], P = 0.02, I² = 86%). In addition, FIB could reduce the pain score on the first and third day after surgery (SMD: -0.46; 95%CI[-0.74, -0.18], P = 0.001, I² = 43%; SMD: -0.62; 95%CI[-0.97, -0.26], P﹤0.001, I² = 58%), as well as after physical activity(SMD: -1.64; 95%CI[-3.00, -0.28], P = 0.02, I² = 83%).

Conclusion

FIB can reduce the incidence of POD in elderly patients undergoing hip surgery without pre-existing cognitive impairment. Additionally, it can lower the delirium scores and pain scores.