Fascia iliaca compartment block for postoperative hip fracture pain: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: The fascia iliaca compartment block has been proposed to reduce postoperative pain and opioid consumption after hip fracture surgery; however, whether these effects translate into clinically meaningful benefits remains uncertain. METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Wanfang Data were systematically searched for randomized controlled trials published through October 2025. The primary outcomes were cumulative opioid consumption within 24 h after surgery and resting pain scores at 24 h. Secondary outcomes included pain scores at 6 and 12 h, the 24-h pain-time area under the curve, time to first analgesic request, functional recovery, and adverse events. The minimum clinically important difference for postoperative analgesic consumption within 24 h was defined as 30 mg of oral morphine equivalents, and the minimum clinically important difference for pain scores was defined as 0.99 cm. Risk of bias was assessed using the Cochrane RoB 2 tool, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation framework. RESULTS: Fourteen randomized controlled trials involving 1231 patients were included. Fascia iliaca compartment block significantly reduced 24-h opioid consumption (mean difference, - 11.07 mg; 95% confidence interval, - 15.34 to - 6.81; P < 0.00001) and resting pain scores at 24 h (mean difference, - 0.51 cm; 95% confidence interval, - 0.82 to - 0.21; P = 0.001). Pain scores at 6 and 12 h after surgery were also significantly reduced. However, apart from the pain score at 6 h post-surgery, the above results did not meet the pre-defined minimum clinically important difference. In addition, fascia iliaca compartment block prolonged the time to first analgesic request and reduced the incidence of opioid-related adverse events. CONCLUSIONS: FICB was associated with reductions in early postoperative pain and opioid consumption after hip fracture surgery; however, the clinical relevance of these benefits appears limited, except possibly for pain relief at 6 h postoperatively. Given the overall certainty of evidence ranging from very low to moderate, routine use of FICB may not be warranted, and further high-quality randomized controlled trials are needed to better define its analgesic efficacy and identify patients most likely to benefit. PROSPERO REGISTRATION NUMBER: CRD420251069610.