Comparative study of fascia iliaca compartment block and three in one block for postoperative analgesia in patients undergoing lower limb orthopedic surgeries

Abstract

Background: The fascia iliaca compartment block and three in one block (two single injections, anterior approach procedures) was compared simultaneously to block the femoral, obturator, genitofemoral and lateral femoral cutaneous (LFC) nerves in patients undergoing lower limb orthopedic surgeries. Study Design: Prospective randomized single-blinded study. Materials and Methods: Sixty patients of ASA I, II and III scheduled for hip and femur shaft surgery under spinal anesthesia were included in the study. On completion of the surgery, patients were randomly divided into two groups, Group I and Group II each consisting of 30 patients. Group I received fascia iliaca compartment block and Group II received three in one block. Patients of both the groups received 35-40 ml of 0.25% bupivacaine. Sensory blockade of femoral nerve, obturator nerve, LFC nerve and genitofemoral nerve, and motor blockade of femoral and obturator nerves were observed by weakness in knee extension and thigh adduction. Duration of analgesia, number of doses of rescue analgesics required in 24 hours, visual analog scale (VAS) scores at rest and during physiotherapy were also noted. Results: Sensory blockade of femoral, obturator and genitofemoral nerves, and motor blockade of femoral and obturator nerves did not differ between the two groups; however, sensory blockade of LFC nerve was significantly higher in Group I. VAS at 12 hours after surgery during movement of 3.43 ± 2.36 in Group I and 4.57 ± 0.15 in Group II were statistically significant (P value = 0.03) but the duration of analgesia between Group I and Group II was not statistically significant (P > 0.05). Conclusion: Fascia iliaca compartment block may represent an attractive alternative to three in one block for treatment of pain at rest and during physiotherapy.