The Effect of Fascia Iliaca Block on Post-Operative Pain in Elderly Patients (≥70 Years Old) Undergoing Hip Fracture Surgery: A Systematic Review.

The aim of this systematic review was to compare post-hip surgery pain outcomes in the elderly population after a fascia iliaca compartment block (FICB) against conventional systemic analgesia (CSA). Our primary outcome was post-operative static and dynamic visual analogue scales (VAS)/numerical rating scales (NRS) as our validated pain measurements. Secondary outcomes were post-operative opioid consumption, incidence of post-operative delirium, and average length of hospital stay. A systematic search strategy was conducted in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from database inception to 6th April 2026. We accepted observational studies and randomised controlled trials comparing the post-operative pain outcomes in elderly patients who received an FICB for their hip fracture against those receiving CSA without any nerve blocks. Risk of bias was assessed with the Cochrane Risk-of-Bias 2 tool for randomised trials (RoB2) and the Newcastle-Ottawa Scale (NOS), depending on the type of study. Certainty assessments were conducted using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. A narrative synthesis was performed without a meta-analysis due to the clinical and methodological heterogeneity seen amongst outcome parameters and measured effects. A total of 228 studies were identified, of which there were 143 from CENTRAL, 45 from EMBASE, and 40 from PubMed. Eleven studies were included after the literature search. The 11 eligible studies included seven randomised controlled trials (63.6%) and four non-randomised studies of interventions (36.4%), totalling 1,844 participants, of which 1,068 (58%) were from control/CSA groups and 776 (42%) were from intervention/FICB groups, wherein the mean age of all participants was 78.7 years. Pain outcome analysis favoured the use of the FICB. The average static pain intensity difference (Δ static pain) in the control group (CG) between POD1 and pre-operative levels was as follows: CG Δ static pain of -2.55 per VAS and -2.67 per NRS. For the FICB group, it was as follows: FICB Δ static pain of -2.86 per VAS and -3.36 per NRS. The average dynamic pain intensity difference (Δ dynamic pain) in the CG between POD1 and pre-operative levels was as follows: CG Δ dynamic pain of -2.83 per VAS. For the FICB group, it was as follows: FICB Δ dynamic pain of -3.82 per VAS. There were no NRS data for the dynamic pain group. Secondary outcome findings were varied in evidence certainty, although a notable point was the significant opioid-sparing effect seen in FICB patients, whilst evidence pertaining to the other outcomes remained equivocal. The FICB, as part of a multimodal analgesia regimen, offers meaningful clinical benefits over CSA in elderly hip fracture patients requiring surgery. With moderate to high evidence certainty, FICB reduced both static and dynamic pain scores and consequently reduced post-operative opioid consumption as well. Average LOS had moderate evidence certainty, suggesting it is unaffected by the inclusion of FICB when compared to the CSA group. Other secondary outcomes, such as post-operative delirium, nausea, vomiting, and pruritus, were deemed inconclusive due to insufficient evidence or low to very low evidence certainty.