Improvement of analgesic efficacy for total hip arthroplasty by a modified ultrasound\u2010guided supra\u2010inguinal fascia iliaca compartment block

Ting Zheng,Chun-Ying Zheng,Bin Hu,Feng-Yi Huang,Xiao-Chun Zheng,Fei Gao

doi:10.1186/s12871-021-01296-8

Ting Zheng, Chun-Ying Zheng + Show 4 more

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https://doi.org/10.1186/s12871-021-01296-8

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Abstract

BackgroundFascia iliaca compartment block (FICB) is an anterior approach to the lumbar plexus block and provides the effective adjunctive analgesia for total hip arthroplasty (THA).MethodsAs a case series study, 28 patients (≥ 65 years old) with THA were received a modified in-plane ultrasound-guided supra-inguinal (S-FICB) as an analgesic adjunct to evaluate the analgesic effectiveness and the local anesthetic diffusion with magnetic resonance imaging (MRI). A combination of propofol and sufentanil was administered to conduct target-controlled infusion.ResultsThe pain scores were 1 (0–4), 2 (1–5), 3 (1–6) and 3 (1–6) at 4, 8, 12, and 24 h. The cumulative opioids were 8 (8–12), 18 (16–32), 28 (24–54) and 66 (48–104) mg of i.v. morphine equivalents at 4, 8, 12, and 24 h. The patient-controlled analgesia (PCA) times were 0 (0–1), 1 (0–2), 2 (0–5) and 5 (3–8) at 4, 8, 12, and 24 h. In lateral, anterior and medial part of thigh, the sensory blockade in 28 patients was 23 (82 %), 21 (75 %) and 19 (68 %) at 5 min; 28 (100 %) at 10 and 20 min. Motor blockade of femoral nerve (FN) and obturator nerve (ON) was present in 13 (46 %) and 3 (11 %) patients at 5 min, 24 (86 %) and 9 (32 %) at 10 min, 26 (93 %) and 11 (39 %) at 20 min. Injectate permeated to the FN and extended superiorly over the surface of iliac muscle (IM) and pectineus muscle (PM) in all patients.ConclusionsThe modified S-FICB has provided an effective postoperative analgesic adjunct after THA with the satisfactory blockade of femoral (FN), obturator (ON) and sciatic (SN) nerves, especially for ON, when compared with the existing techniques.

Highlights

Fascia iliaca compartment block (FICB) is an anterior approach to the lumbar plexus block and provides the effective adjunctive analgesia for total hip arthroplasty (THA)
Injectate permeated to the femoral nerves (FN) and extended superiorly over the surface of iliac muscle (IM) and pectineus muscle (PM) in all patients
THA usually results in the severe pain that mainly arises from the site of surgical insertion in the distribution of the lateral femoral cutaneous nerve (LFCN)

Summary

Introduction

Fascia iliaca compartment block (FICB) is an anterior approach to the lumbar plexus block and provides the effective adjunctive analgesia for total hip arthroplasty (THA). THA usually results in the severe pain that mainly arises from the site of surgical insertion in the distribution of the lateral femoral cutaneous nerve (LFCN). The subsequent hip joint pain originates from sensory components of the femoral nerves (FN), obturator nerves (ON) and sciatic nerves (SN). FN is the most significant contribution to the hip joint pain. The lumbar plexus block has been used to provides postoperative analgesia for THA, but is limited in the hip surgery because of the high incidence of complications and position requirements. The fascia iliaca compartment block (FICB) is considered as an anterior approach to the lumbar plexus block [1]

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