Ultrasound Guided Fascia Iliaca Block versus Femoral Nerve Block for Post Operative Analgesia for Patient Undergoing Total Knee Arthroplasty

Abstract

Abstract Background Total knee arthroplasty (TKA) is commonly performed in patients with end-stage osteoarthritis or rheumatic arthritis of the knee to relieve joint pain, increase mobility, and improve quality of life. Multimodal techniques featuring peripheral nerve blocks have demonstrated a significant advantage in perioperative pain relief for TKA patients. Peripheral nerve blocks have gained more attention because of the discovery of new and more trustworthy anesthesia medications and developments in technology and anesthesia. Peripheral nerve blocks can also be used for anesthesia of the operation area and are commonly used for postoperative analgesia being with general anesthesia. Aim of the Study To compare the effect of Fascia iliaca versus femoral nerve block on postoperative anaelgesia in patients undergoing TKA. Patients and Methods This is a prospective randomized clinical trial study was conducted in Ain Shams University Hospitals within a period of 6 months. Seventy adult patients scheduled for total hip arthroplasty (THA), under spinal anesthesia were included in this study and randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group I (FICB group) received ultrasound guided Fascia iliaca compartment block (FICB) and Group II (FNB group) received ultrasound guided femoral nerve block. Results There was a statistically significant mean in FNB group compared to FIB group according to VAS score after 6 hrs postoperative and shows significant higher mean in FNB group after 12 hrs and 24 hrs postoperative. Also, a statistically significant increase mean/hrs in FIB group compared to FNB group was found according to first time to ask analgesia and also shows statistically significant higher mean in FNB group compared to FIB group according to total pethidine given (mg). At PACU arrival there is no difference between two groups as two groups were recovering from anesthesia then fascia illiaca block group showed the best response as regard as pain control post operatively for 12 hours postoperative then there is no statistical difference between two groups. There was statistically significant difference between groups as regard as visual analog score. As regard to total dose of morphine used in each group, facia illiaca block scientifically used less amount of morphine than control group (P < 0.001). Conclusion The fascia iliaca block and femoral nerve block provide the same analgesic effect during early post operative period; however after 6 hrs, fascia iliaca block provides a more efficient pain control and less morphine consumption.