Suprainguinal versus infrainguinal fascia iliaca compartment block for hip surgery: a systematic review and meta-analysis

Background: Effective postoperative analgesia is essential after hip surgery to facilitate early mobilization and reduce opioid consumption. The fascia iliaca compartment block (FICB) is commonly used for perioperative analgesia, with both suprainguinal and infrainguinal approaches described; however, their relative efficacy remains uncertain. This systematic review and meta-analysis compared the analgesic effectiveness of suprainguinal versus infrainguinal FICB in hip surgery. Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted from inception to the final search date. Randomized or prospective comparative studies involving adult patients undergoing hip surgery and directly comparing suprainguinal with infrainguinal FICB were included. Primary outcomes were time to first rescue analgesia and postoperative opioid consumption. Secondary outcomes included pain scores and adverse events. Data were pooled using random-effects models, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Results: Seven studies comprising 660 patients met the inclusion criteria. Suprainguinal FICB significantly prolonged time to first rescue analgesia compared with the infrainguinal approach (mean difference 121.40 minutes; 95% CI 4.60–238.19), with substantial heterogeneity. Postoperative opioid consumption was significantly lower with suprainguinal FICB (standardized mean difference −1.35; 95% CI −2.29 to −0.41). Pain scores generally favored the suprainguinal approach, particularly between 6 and 24 hours postoperatively. No major block-related complications were reported, and adverse event rates were comparable. Conclusion: Suprainguinal FICB provides superior postoperative analgesia and reduces opioid requirements compared with the infrainguinal approach in patients undergoing hip surgery, supporting its preferential use within multimodal analgesia strategies.