A comparative study on combined general anesthesia with either continuous fascia iliaca block or epidural anesthesia in patients undergoing lower limb orthopedic surgeries

Abstract

Introduction The purpose of this study was to compare between epidural anesthesia and continuous fascia iliaca block in adults patients undergoing fixation of neck femur or knee arthroplasty including comparison of analgesic efficacy, side effects, and complications. Patients and methods The study was performed upon 60 patients, aged 20-60 years, and randomly distributed among two groups. Group A included 30 patients who received lumber epidural anesthesia, using Tuohy needle 18 G and epidural catheter 20 G, injected initially with 15 ml bupivacaine HCl 0.25% then 6-8 ml/h bupivacaine HCl 0.125% as continuous epidural infusion for 12 h postoperatively. Group B included 30 patients who received fascia iliaca block using Tuohy needle 18 G, injected initially with 20 ml bupivacaine HCl 0.25%, then an epidural catheter 20 G was threaded through the needle and another 20 ml of local anesthetic was injected, followed by 8-10 ml/h bupivacaine HCl 0.125% injected as continuous epidural infusion into the plane for 12 h postoperatively. Results Regarding the technique time, the fascia iliaca group B was significantly faster than the epidural group A. The results showed that performing continuous fascia iliaca block was a significantly faster technique, providing fewer complications such as hypotension, postoperative vomiting, and urinary retention and more patient satisfaction in comparison with epidural anesthesia. Conclusion Continuous fascia iliaca block provided effective unilateral analgesia in patients undergoing fixation of fractured femur neck or shaft or knee arthroplasty with a high patient satisfaction rate, low incidence of hemodynamic instability, and low incidence rate of complications when compared with epidural analgesia.