The effect of fascia Iliaca compartment block in patients with total hip arthroplasty under general vs. spinal anesthesia: a meta-analysis of randomized controlled trials

This meta-analysis aimed to evaluate the efficacy of the fascia iliaca compartment block (FICB) in reducing postoperative opioid consumption and pain scores in patients undergoing total hip arthroplasty (THA) under either general or spinal anesthesia. Following PRISMA guidelines, we searched PubMed, EMBASE, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) comparing FICB with placebo/no block in THA patients. The primary outcome was postoperative opioid consumption in the first 24 h, while secondary outcomes included pain scores at 6, 12, and 24 h at rest postoperatively, and the occurrence of complication. Subgroup analyses were performed based on anesthesia type (general vs. spinal anesthesia). Furthermore, sensitivity analysis and trial sequential analysis (TSA) were conducted for primary outcome. Twelve RCTs involving 928 patients were included. FICB significantly reduced 24-hour opioid consumption (mean difference: -8.21 mg, 95% CI: -11.50 to -4.91, P < 0.001). Heterogeneity was low under general anesthesia (I² = 0%) but high under spinal anesthesia (I² = 85%). However, the subgroup difference was not significant. Pain scores at 12 h favored FICB (MD: -0.52, 95% CI: -0.80 to -0.23, P < 0.001), but no significant differences were observed at 6, 24, and 48 h. FICB reduced the incidence of postoperative nausea and vomiting (RR: 0.61, 95% CI: 0.39–0.96, P = 0.03). FICB demonstrated a borderline significant increase in the risk of quadriceps weakness (RR: 3.25, 95% CI: 1.02 to 10.37, P = 0.05). No significant subgroup differences were detected among secondary outcomes. TSA indicated insufficient evidence for conclusive opioid-sparing effects. GRADE ratings revealed low-to-moderate quality evidence for most outcomes. FICB reduces early postoperative opioid consumption at 24 h and the pain score at 12 h with low quality evidence. The observed heterogeneity may be partly attributable to anesthesia type, but no subgroup differences were detected, Further large-scale RCTs are needed to clarify the optimal use of FICB in special anesthesia contexts. The protocol of this meta-analysis has been registered in the PROSPERO database (https://www.crd.york.ac.uk/PROSPERO; Registration Number: CRD42025634214).