Several key issues should be emphasized in assessing clinical benefits of a regional block for elderly patients undergoing hip arthroplasty under spinal anesthesia.

This matters arising article was written in response to the recent article by Chen et al regarding "Effect of perioperative ultrasound guided fascia iliaca compartment block in elderly adults with hip fractures undergoing arthroplasty in spinal anesthesia-a randomized controlled trial", which is published on BMC Geriatrics at February, 2023. The main findings of Chen et al' study are that the fascia iliaca compartment block (FICB) before spinal anesthesia reduces positioning pain, shorten procedure time of spinal anesthesia, prolongs duration of analgesia and improves quality of early postoperative recovery, but reduces postoperative muscle strength. While the efforts of using the existing technique by Chen et al. to optimize patient comfort during spinal anesthesia procedure should be acknowledged, we have noted several issues about methods and results of this study that are not well addressed, such as the lack of detailed perioperative analgesic scheme, clinical significance of reduced positioning pain during spinal anesthesia procedure with the FICB, adverse motor effect of the FICB, time needed for additional FICB, and others. We believe that clarification of these issues is helpful for quality improvement of further randomized clinical trials assessing the benefits of a regional block in elderly patients with hip fractures undergoing arthroplasty under spinal anesthesia.