Fascia Iliaca Compartment Block Group Research Articles

A Comparative Study of the Effect of Pericapsular Nerve Block (PENG) and Ultrasound-guided Fascia Iliaca Blocks on Postoperative Pain of Intertrochanteric Fractures

Background: Previous anesthesia blocks often failed to provide complete pain relief and were associated with weakness in the lower limbs, which hindered the essential mobility of patients undergoing hip surgery. Recently, the pericapsular nerve group block (PENG) has emerged as a promising alternative for managing postoperative pain following hip fracture surgery. Objectives: This study aimed to compare pain reduction between the pericapsular nerve group block (PENG) and the fascia iliaca compartment block (FICB) in patients who underwent intertrochanteric hip surgery. Methods: This randomized, double-blind clinical trial included 41 patients who were randomly assigned to either the pericapsular block group (PENG) or the ultrasound-guided (FICB). The primary outcome was pain relief, assessed using the postoperative Visual Analog Scale (VAS) score. Secondary outcomes included the dose of morphine consumed, the time of first morphine request, patient satisfaction with analgesia, and complications. Results: There was no significant difference between the PENG and FICB groups in terms of pain scores at any of the studied intervals (P-value > 0.05). The dose of morphine consumed and the time to the first morphine request were similar for both methods, with no significant difference (P-value > 0.05). The complication rates were 15% for the PENG group and 8.3% for the FICB group, with no significant difference observed (P-value > 0.05). Conclusions: Both pericapsular and fascia iliaca blocks effectively reduced postoperative pain in patients undergoing intertrochanteric fracture surgery. Additionally, both methods were well tolerated by patients with no significant complications. However, there was no evidence to suggest that PENG is superior to FICB in terms of pain reduction.

Effect of epinephrine-mixed fascia iliaca compartment block on bleeding in total hip arthroplasty: A single-center retrospective study.

Fascia iliaca compartment block (FICB) reduces opioid consumption and pain scores after total hip arthroplasty (THA), and has recently been widely applied. We investigated whether FICB could also reduce postoperative bleeding. One hundred and fifteen consecutive patients who underwent elective THA under general anesthesia over 5 months were retrospectively analyzed. They were divided into 2 groups: the FICB group received an epinephrine-mixed FICB procedure and the control group did not receive any block. Using the hematocrit measured at 4 different time points (preoperative and 1, 24, and 48 hours after surgery), the estimated blood loss (EBL) was calculated for 3 different time periods (0-1, 1-24, 24-48 hours after surgery). EBL at 1 to 24 hours (226 vs 398 mL, P = .008) was significantly lower in the FICB group than in the control group. Additionally, the number of packed red cell (PRC) units transfused per patient over 48 hours was 0.38 units in the FICB group, which was significantly lower than the 0.70 units used in the control group (P = .040). Epinephrine-mixed FICB in THA has the potential to reduce postoperative bleeding in the first 24 hours after surgery as well as reduce PRC transfusion requirements.

Ultrasound-Guided Fascia Iliaca Block Versus Pericapsular Nerve Group Block Before Positioning for Spinal Anesthesia in Patients Undergoing Surgery for Neck of Femur Fracture: A Comparative Study.

Introduction Positioning patients with femur fractures for spinal anesthesia can be challenging due to pain. Regional anesthesia techniques, such as the fascia iliaca compartment block (FICB) and pericapsular nerve group block (PENG), have facilitated patient positioning and improved analgesia. This study compared the efficacy of ultrasound-guided FICB and PENG for pain management during the positioning of the patient for spinal anesthesia in neck of femur fracture surgeries. Aim of the study Ultrasound-guided fascia iliaca compartment block versus pericapsular nerve group block before positioning for spinal anesthesia in the neck of femur fracture surgeries. Materials and methods This prospective, randomized, single-blinded, and comparative study was conducted at Dr. DY Patil Hospital, Pune, from November 2022 to January 2024 and included 60 patients with neck and femur fractures scheduled for surgery under spinal anesthesia. Patients were randomly assigned to receive either ultrasound-guided FICB (n = 30) or PENG (n = 30) with 0.25% 20 ml of bupivacaine before positioning for spinal anesthesia. The primary outcome was to assess the Visual Analog Scale (VAS) score for pain before and after the block. Secondary outcomes included assessment of hemodynamic parameters, patient satisfaction, and adverse effects. Results The number of days since fracture in FICB was 2.73±0.98 and in PENG was 3.37±1.9 was comparable with no significant difference between them (p-value =0.11). The mean VAS score after the block was significantly lower in the PENG group compared to the FICB group (3.33±1.73 vs. 4.43±1.3, p = 0.007), indicating better pain relief with PENG. Both techniques were comparable in terms of hemodynamic stability. Patient satisfaction was high and similar in both groups. No significant adverse effects were reported. Conclusion This study observed that the ultrasound-guided pericapsular nerve group block was superior to the fascia iliaca block in providing better analgesia, good patient satisfaction, and hemodynamic stability during positioning for spinal anesthesia.

Fascia Iliaca Block versus Femoral Nerve Block as Post Operative Analgesia in Total Hip Arthroplasty

Abstract Background Total hip arthroplasty (THA) are common surgical procedures for treatment of the degenerative disorders and traumatic diseases. However, a majority of patients often experience moderate to severe postoperative pain after THA. Postoperative pain control has a significant impact on earlier ambulation, initiation of physiotherapy, and better functional recovery. In addition, effective pain control would lower the length of hospital stay and the risk of thrombotic events which improves patients’ satisfaction. Objective To assess the efficacy and safety of FICB compared with FNB. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into two groups (n = 20; each); group FICB and FNB group. Group FICB: Patients (n = 20) of this group received ultrasound guided Fascia iliaca compartment block (FICB) before spinal anesthesia using 20-40 ml of 0.25% bupivacaine. Group FNB: Patients (n = 20) of this group received ultrasound guided femoral nerve block (FNB) before spinal anesthesia using 20-40 ml of 0.25% bupivacaine. Results The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia. Demographic data, post-operative hemodynamics, and sedation score were also assessed. Conclusion Fascia iliaca compartment block is effective for pain relief during the early post- operative period after total hip arthroplasty. Meanwhile, it can reduce the cumulative meperidine consumption and the risk of opioid-related adverse effects.

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Compartment Block (FICB) and Outcomes in Preoperative Fast-track Geriatric Patients with Hip Fracture: A Single-center Retrospective Study

Objective: This study aimed to evaluate the analgesic efficacy of preoperative fascia iliaca compartment block (FICB) in terms of preoperative pain score reduction in geriatric hip fracture patients. Secondary objectives were to compare opioid consumption, procedure-related complications, and patient outcomes. Materials and Methods: This single-center retrospective study included patients aged 65 or older with hip fractures who experienced moderate to severe pain in a tertiary care university hospital from January 2019 to July 2021. The variables collected for analysis were patient baseline characteristics and the pain score at rest, including during movement from the beginning of service and subsequently each morning after admission until the day of surgery. Results: A total of 439 patients were included in this study, 109 patients (24.8%) receiving preoperative FICB (FICB group). When comparing the FICB and non-FICB groups, a significant reduction in pain scores was observed on postadmission day 1, both at rest (0 [IQR=0-4] vs. 0 [IQR=0-2], p<0.001) and during movement (0 [IQR=0-4] vs. 0 [IQR=0-2], p=0.018). This difference in pain reduction persisted on day 2 during movement (3 [IQR=0-5.75] VS 0 [IQR=0-3], p=0.001). No significant differences in preoperative opioid consumption or postoperative morbidities were observed between these two groups, and no complications related to the procedure were observed. Conclusion: For patients experiencing moderate to severe preoperative pain at the beginning of treatment, preoperative FICB can reduce pain scores for up to 2 days.

A comparison of fascia iliaca compartment block with intravenous analgesia to improve pain control in patients with femoral fracture.

The most common approach to managing severe pain following femoral fracture is with intravenous systemic analgesics, such as opioid analgesics and non-steroidal anti-inflammatory drugs associated with side effects such as respiratory depression, nausea, and vomiting. These side effects might be intolerable in trauma patients and may result in under treatment of pain. Improving the quality of analgesia may reduce these intolerable side effects. Our study compared the efficacy of fascia iliaca compartment block (FICB) with intravenous analgesics for preoperative pain management of femoral fractures. The study was a quality improvement prospective randomised study, where 50 patients aged between 18 and 65 years, and American society of anesthesiologists I and II were recruited into two groups. Group A received FICB with a combination of 0.4 mL/kg of 0.5% plain bupivacaine and adrenaline 1:200,000 made up to 30 mL, while group B received placebo FICB using 30 mL normal saline. Also, group B received a combination of intravenous paracetamol 15 mg/kg not exceeding 900 mg and tramadol 1 mg/kg not exceeding 100 mg, while group A received an equal volume as normal saline intravenously. The study revealed no significant difference in age, gender, associated injuries, X-ray description of fractures, and mechanism of injuries; however, there was a significant difference in the NRS-pain score at 30 min, summed pain intensity difference for 4 h and patient satisfaction in the FICB group compared to the standard group. The study revealed that FICB results in better pain control compared to a combination of intravenous tramadol and paracetamol in patients with femoral fractures.

Pericapsular nerve group block and lateral femoral cutaneous nerve block versus fascia iliaca block for multimodal analgesia after total hip replacement surgery: A retrospective analysis.

Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and early discharge. Fascia iliaca compartment block (FICB) has been recommended since it offers good pain control with a low risk of motor block. Pericapsular nerve group (PENG) block with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FICB that offers better pain control with a considerably lower risk of motor block. We aimed to compare the aforementioned blocks and determine which one yielded the lowest numeric rating scale (NRS) score. We designed a retrospective analysis of patients undergoing elective total hip arthroplasty. The primary outcome was the NRS score at 6, 12, and 24 hours. The secondary outcomes were total opioid consumption, time to first PRN opioid, and time to first postoperative ambulation. 52 patients were recruited, (13 PENG plus LFCN, 39 FICB). PENG plus LCFN resulted in a lower NRS at all three-time points (mean difference and 95%CI at 6 h 0.378 [-0.483; 1.240], at 12 h 0.336 [-0.378; 1.050], and at 24 h 0.464 [0.013; 0.914] P = 0.02). Moreover, less PRN opioids were requested in the PENG plus LCFN vs. FICB group (0 [0;7.5] vs 60 [15;80] milligrams of morphine equivalents, P = 0.001). No delay in the first ambulation or initiation of physical rehabilitation was reported in either group. PENG plus LCFN seems to offer better pain control and lead to less PRN opioids. Neither block hindered physical therapy nor ambulation. These results need to be confirmed with a larger prospective and randomized study.

Ultrasound-guided femoral nerve block versus fascia iliaca compartment block for femoral fractures in emergency department: A randomized controlled trial.

Femoral fractures are one of the most debilitating injuries presenting to the emergency departments (EDs). The pain caused by these fractures is typically managed with opioids and adjunctive regional analgesia. These approaches are often associated with adverse side effects. Thus, appropriate alternative methods should be thoroughly investigated. To evaluate ultrasound-guided femoral nerve block (FNB) with ultrasound-guided fascia iliaca compartment block (FICB) in femoral fractures, to determine which provides better analgesia and less opioid requirement. This study was a randomized clinical trial performed on adult patients presenting to the ED within 3 h of isolated femoral fracture with initial numerical pain rating scale (NRS-0) score of more than 5. The patients were randomized to receive FNB or FICB. The outcomes were block success rates, pain at 20 (NRS-20) and 60 (NRS-60) min after the end of the procedures, as well as the number and total dose of fentanyl administration during ED stay. Eighty-seven patients were recruited (40 FNB and 47 FICB). Success rates were 82.5% in FNB and 83.0% in FICB group, with no significant difference between the groups. NRS-20, NRS-60, the number of patients who received supplemental fentanyl, and the total dose of administered fentanyl were significantly lower following FNB. However, the length of the procedure was significantly lower in the FICB group. Both FNB and FICB are effective in pain reduction for fractures of femur, but FNB provides more pain relief and less need for supplemental fentanyl.

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

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.

Comparison between pericapsular nerve group block and fascia iliaca compartment block for perioperative pain control in hip surgeries: A meta-analysis from randomized controlled trials

ABSTRACT Background To alleviate pain related to hip surgeries, pericapsular nerve group block (PENG) is introduced as an innovative approach aims to improve analgesia without interfering with muscle motor activity. In this study, we compared the effectiveness and safety of PENG block to fascia iliaca compartment block (FICB) for managing acute pain related to hip operations. Methods Systematically looking through electronic databases, we only included randomized controlled trials (RCTs) involving hip surgeries. The perioperative pain scores at various time periods, postoperative narcotic demands in 24 h, the time of first opioid request, quality of patient positioning during spinal anesthesia (SA), patients’ satisfaction, and adverse event incidence between the two groups were obtained through the study. Results The analysis included nine RCTs with a total of 524 patients. Compared to the FICB, PENG significantly reduced the pain scores early at 30 min post-block during positioning for SA (SMD = −0.98, 95% CI: −1.76 to −0.20, P = 0.01), improved the quality of positioning, and enhanced patient satisfaction. However, no significant differences were observed between PENG and FICB regarding pain scores postoperatively at different time periods during rest and exercise. Patients in the FICB group had more narcotic demands at 24 h post-surgical (MD = −8.09, 95% CI: −14.25 to −1.93, P = 0.01). Otherwise, no differences were detected regarding the time of first opioid request, postoperative complications, or length of hospitalization. Conclusions PENG offered better benefits in terms of reducing pain, while the patient is being positioned for SA and minimizing narcotic consumption over the first 24 hours following hip surgeries.

Effect of perioperative ultrasound guided fascia iliaca compartment block in elderly adults with hip fractures undergoing arthroplasty in spinal anesthesia—a randomized controlled trial

BackgroundFor elderly adults undergoing hip arthroplasty, fascia iliaca compartment block (FICB) is often used before spinal anesthesia to reduce the pain of posture placement. However, the impact of FICB within 48 h needs further study.Methods89 elderly adults scheduled to undergo arthroplasty for hip fracture were enrolled and randomized into the FICB group (n = 45) and the control group (n = 44). The fascia iliaca on the operated side was located using ultrasound, and a puncture needle was placed under the fascia iliaca. The FICB group was injected with 40 ml of 0.5% ropivacaine, and the control group was injected with 40 ml of normal saline. Spinal anesthesia was performed after 20 min. Our primary outcome measures were: duration of analgesia, muscle strength, and Quality of Recovery (QoR).ResultsThe duration of analgesia in the FICB group was 403.5 ± 39.6 min, which was longer than that (357.5 ± 35.9 min) of the control group (P = 0.012). There were 19 (42.2%) patients with muscle strength of grade 4 in the FICB group and 36 (81.8%) patients with muscle strength of grade 4 in the control group. FICB group was lower (P < 0.001). QoR-15 at 24 h after surgery was 114.1 ± 8.3 in the FICB group and 104.6 ± 8.4 in the control group (P < 0.001). QoR-15 at 48 h after surgery was 122.7 ± 8.4 in the FICB group and 120.5 ± 9.5 in the control group (P = 0.232).ConclusionsFor elderly adults with hip fractures, FICB provided longer analgesia and improved 24-h QoR, but reduced postoperative muscle strength.Trail registrationChinese Clinical Registry Center, ChiCTR2200056937, 23/02/2022.

Analgesic effect of pericapsular nerve group block on elderly patients undergoing hip replacement

Background/Aim. Pericapsular nerve group block (PNGB) does not affect the motor nerve while blocking the obturator and femoral nerves. The aim of the study was to determine the application value of PNGB for hip replacement in the elderly. Methods. Ninety elderly patients who underwent hip replacement from March 2019 to October 2020 were randomly divided into the fascia iliaca compartment block (FICB) group and the PNGB group. FICB and PNGB were performed prior to subarachnoid block (SAB). Their baseline data, operation conditions, incidence of adverse reactions, visual analog scale (VAS) score, heart rate (HR), mean arterial pressure (MAP), plasma cortisol (COR), and epinephrine (E) levels were compared. Results. VAS score, E, and plasma COR levels in the PNGB group were lower than those in the FICB group at time points T2?T4 (T2: 10 min after nerve block; T3: at position changing; T4: after position changing) (p &lt; 0.001). There were no significant differences in HR and MAP between the two groups at any time point (p &gt; 0.05). In the PNGB group, the ultrasonic imaging time was shorter, the time point of pressing patient-controlled analgesia (PCA) for the first time was later, and the numbers of pressing PCA were fewer than those of the FICB group (p &lt; 0.001). No local anesthetic poisoning took place after the nerve block, and no hematoma at the puncture site, nerve injury, nausea and vomiting, dizziness, or delirium occurred. Conclusion. Both FICB and PNGB prior to SAB were highly safe for hip replacement in the elderly; however, PNGB has shorter ultrasonic imaging time, better analgesic effect, and milder oxidative stress, so it is worth applying it clinically.

The analgesic efficacy of pericapsular nerve group block in patients with intertrochanteric femur fracture: A randomized controlled trial.

The aim of this study is to evaluate analgesic efficacy of pericapsular nerve group (PENG) block in patients with intertrochanteric femur fracture (IFF). This double-blinded randomized controlled trial in patients with IFF scheduled for proximal femoral nail antirotation (PFNA) between December 2020 and November 2021. The primary outcome was VAS scores during exercising at 6 h after surgery; secondary outcomes were pain during exercising and rest, intraoperative dose of remifentanil, cumulative dose of postoperative fentanyl, postoperative analgesia satisfaction scores, and ratio of quadriceps weakness. A total of 50 patients were randomly divided into PENG block group (n = 25) or fascia iliaca compartment block (FICB) group (n = 25). Exercising VAS scores at 6 h after surgery were significantly lower in PENG block group than that in FICB group (2 (2, 4) vs. 6 (4, 7), P < 0.001). The intraoperative dose of remifentanil and cumulative dose of postoperative fentanyl by patient-controlled intravenous analgesia within 24 h after surgery in PENG block group were significantly lower than in FICB group (both P < 0.001). Postoperative analgesia satisfaction scores in PENG block group were significantly higher than those in FICB group (P = 0.016). The ratio of quadriceps weakness at 6 h after surgery was significantly higher in FICB group than PENG block group (48% vs. 0%, P < 0.001). Compared to FICB, ultrasound-guided PENG block may provide better postoperative pain relief in patients with IFF, with less pronounced quadriceps weakness.

The Impact of the Fascia Iliaca Block Beyond Perioperative Pain Control in Hip Fractures: A Retrospective Review.

BackgroundGeriatric hip fractures are common injuries that are associated with high morbidity and mortality. Adequate pain control remains a challenge as the altered physiology in elderly patients makes use of traditional analgesics challenging. The use of regional anesthetics, specifically the fascia iliaca compartment block (FICB), in the perioperative period has been shown to decrease opioid use in this population. This study aimed to investigate the effect the FICB had on pain control, length of stay, readmissions, and complications in a 30-day postoperative period.MethodsThis was a retrospective cohort study comparing patients who sustained hip fractures; one cohort (110 patients) received a preoperative fascia iliaca block with continuous infusion (FICB), whereas the other cohort (110 patients) did not receive a block (NO-FICB). Both cohorts were from level II trauma centers. Data were collected between 2016 and 2019. Descriptive statistics was performed to describe and summarize the data. Bivariate analysis was performed using chi-square test, with 2 tailed P-values ≤ .05 were considered statistically significant.ResultsThe FICB group had a lower length of stay (3.9 days vs 4.8 days; P < .001), and lower pain scores on post-operative days 2 and 3 (P = .019). There was no difference in time from admission to surgery (P = .112) or narcotic use between cohorts (P = .304). However, the FICB group was more likely to discharge to a skilled nursing facility (P=.002), and more likely to be readmitted within 30 days (P = .047). There were no differences in medical complications or mortality between the 2 groups.ConclusionsThe primary study endpoint, length of stay, was found to be significantly shorter in the patients who underwent the FICB vs the group who did not undergo the FICB. Pain scores on POD2 and POD3 were lower in patients who received a FICB. This study adds to the body of evidence that the FICB is an effective addition to a multimodal pain pathway.Level of EvidenceLevel III Evidence – Retrospective Cohort Study

A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture.

Elderly patients with various comorbidities are more likely to suffer from proximal femur fractures. It is also a painful fracture, and poor pain management can have serious physiological and psychological consequences, such as acute delirium. Purpose. The aim of this study is to compare the efficacy of ultrasound-guided transmuscular (anterior) quadratus lumborum block (QLB) versus infrainguinal fascia iliaca compartment block (FICB) in proximal femur fractures for postoperative analgesia. Patient-reported pain on the visual analogue scale (VAS), analgesic demand, and ambulation were the key factors. Patients and Methods. This prospective, randomised trial was done after receiving approval from the institute' study ethical committee. In this study, ultrasound-guided infrainguinal fascia iliaca compartment block was compared to ultrasound-guided anterior quadratus lumborum block using 50 ml of bupivacaine 0.25%, with a maximum dose of 2.5 mg/kg at the end of surgery after spinal anaesthesia in 128 patients (64 patients in each group). Nalbuphine was given as rescue analgesia if VAS >3. Our 1st outcome was the first rescue analgesia and total analgesic consumption in the 1st 24 hours; the 2nd outcome was the time patients started to ambulate. Results. Postoperative pain perception was substantially greater in the FICB group starting from 30 min (P value 0.022) till 24 hours (P value <0.001), and they received a considerably larger total narcotic dose (14.1 ± 3.5) than patients in the QLB group (7.9 ± 3.4), P value (<0.001∗). The time required to achieve first rescue analgesia was much less in the FICB group (8.5 ± 2.2) compared to the QLB group (14.1 ± 4.5), P value (<0.001∗), and they took much longer to ambulate (22.3 ± 4.8) when compared to the QLB group (20.1 ± 4.6), P value (0.011∗). Hypotension (1.6%) was detected mainly in the QLB group, whereas poor fascial separation (1.6%) was observed only in the FICB group. There were no significant differences in complications between both the FICB and QLB groups. Conclusion. Patients receiving postoperative anterior QL block for proximal femur fracture demonstrated delayed first rescue analgesia and lower total nalbuphine consumption with early ambulation than patients who received FICB.

Effects of Perioperative Fascia Iliaca Compartment Block on Postoperative Pain and Hip Function in Elderly Patients With Hip Fracture.

PurposePain management is a challenging issue in elderly patients with hip fracture. Despite the accepted clinical outcomes following hip surgery, pain and prolonged recovery time are the most difficult consequences associated with the rehabilitation process. The purpose of this study was to evaluate pain relief and functional improvement associated with the Fascia Iliaca Compartment Block (FICB) during the perioperative period of elderly patients with hip fracture.Patients and methodsThis study included 120 elderly patients with hip fracture, who were admitted to our institution between January 2019 and December 2020. The participants were subsequently randomly divided into the routine analgesia (RA) and fascia iliaca compartment block (FICB) groups. Inter-group differences were compared via VAS scores at rest and during movement, Harris hip scores (HHS), presence of complications, adverse events after surgery, and length of hospital stay.ResultsThe FICB group VAS scores at rest at 6 hour, 1 and 3 days, and 1 week after surgery were significantly lower than the RA group (P < .05). Moreover, the FICB group VAS scores with movement were markedly lower at 6 hour, 1 and 3 days, as well as 1 and 2 weeks after surgery (P < .05). The HHS of the FICB and RA groups were (53.41±8.63) and (40.02±9.61), respectively, on the seventh day after surgery, and the difference was statistically significant (P < .05). The incidence of postoperative complications and adverse events in the FICB group were not statistically different from the RA group. The average hospital stay of the FICB group was 2.12 days shorter than the RA group, but the difference did not reach statistical significance (P = .13).ConclusionFICB provides superior analgesic effect both at rest and with movement, along with rapid short-term recovery of hip function following surgery in elderly patients with hip fracture, without increasing postoperative complications or adverse events.

Pericapsular Nerve Group Block (PENG) and Fascia Iliaca Compartment Block (FICB) for Positioning Patients with Hip Fractures for Spinal Anaesthesia: A Comparative Study Between The Two Blocks

Background: Hip fractures are a common and disabling injury caused by osteoporosis of the joints, and they have a significant socioeconomic impact. Any movement at the hip joint, whether during the transfer to the hospital or during a radiological procedure followed by OT, causes excruciating pain. Multiple comorbidities increase the need for regional analgesia and anaesthesia in elderly people. The primary purpose was to compare the analgesic efficacy of ultrasound guided supra inguinal FICB to that of PENG block for positioning during spinal anaesthesia. Comfort of anaesthetist while giving spinal anaesthesia and patient’s acceptance score were secondary objectives.&#x0D; Methods: The 60 patients in this prospective, double-blinded, randomized controlled research were scheduled to undergo elective surgery for hip fractures under spinal anaesthesia. They were allotted in two groups- group FICB(n=30) and group PENG(n=30). Ultrasound guided Supra inguinal FICB was performed in FICB group and PENG block was performed in the PENG group with 20ml of 0.25% bupivacaine in each group. Evaluation of pain before intervention, just before positioning and while positioning patients for spinal anaesthesia was done using NRS score. Comfort of the anaesthetist while positioning for spinal anaesthesia and patient acceptance was also assessed.&#x0D; Results: The NRS score did not differ significantly between the two groups (p= 0.853). On a scale of 0 to 3, the anaesthetist's comfort delivering spinal anaesthesia did not differ significantly between the two groups (p= 0.553). There was no statistically significant link between anaesthesia acceptance and group preference (p= 0.504)&#x0D; Conclusion: The newly invented PENG block to facilitate sitting positioning in fracture hip joint patients for spinal anaesthesia was equally effective to supra inguinal FICB.

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial.

This study compared the effects of the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca compartment block (FICB) on postoperative analgesia and quadriceps strength following total hip arthroplasty under general anesthesia. A total of 58 patients were randomized to receive either PENG block (PENG group) or supra-inguinal FICB (FICB group) following anesthetic induction. The primary outcomes were the postoperative pain scores. Patients were randomized to receive either PENG block or supra-inguinal FICB following anesthetic induction. Pain scores at rest and with movement were assessed preoperatively, at the postanesthesia care unit (only at rest), and at 6, 24, 36, and 48 h postoperatively. Opioid consumption was also assessed for 48 h postoperatively. Quadriceps strength measurements were performed preoperatively, at 6, 24, and 36 h postoperatively. In total, 54 patients completed the study: 27 in the PENG group and 27 in the FICB group. Despite lower pain scores at rest in the PENG group at postoperative 6 and 24 h, there were no significant differences in the pain scores at rest and during movement between the two groups during postoperative 48 h in the linear mixed model analysis (p = 0.079 and p = 0.323, respectively). Cumulative opioid consumption up to postoperative 48 h was also similar in the two groups (p = 0.265). The changes in quadriceps strength measurements in the operative leg and the nonoperative leg were not significantly different between the groups (p = 0.513 and p = 0.523, respectively). The PENG block may have similar analgesic efficacy to the supra-inguinal FICB. No difference was detected in the quadriceps strength between the patients receiving these two blocks.

Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: A double-blind prospective randomized controlled clinical trial

BackgroundFascia iliaca compartment block (FICB) is a common regional analgesic strategy in hip fracture surgery but, recently it has been suggested that FICB may not provide enough analgesia. Pericapsular nerve group block (PENG) is a novel method for hip analgesia which its efficacy is not well established yet. The aim of this study was to the effect of the PENG block in the control of the hip fracture pain as well as to compare the effectiveness of the PENG compared with FICB. HypothesisThe hypothesis of this study was that the PENG block could be a good alternative to the FICB in hip fracture analgesia. Materials and methodsThis randomized controlled clinical trial was conducted in the Imam- Hossein Hospital, Tehran, Iran; between 2018 and 2019. Hip fracture patients were randomly divided into two groups; Group A (n=22) received FICB and Group B (n=30) received PENG block. ResultsThere was no significant difference between VAS score before blocks procedure between two groups (p=0.37). After 15minutes of blocks and after 12hours of post-surgery, VAS score significantly reduced in the PENG block group compared with the FICB group (p=0.031; p=0.021, respectively). The first time of the analgesic consumption after surgery was significantly longer in the PENG block compared with the FCIB (p=0.007). Compared with the FICB group, the total dose of morphine consumption during 24hours significantly reduced in the PENG block (p=0.008). ConclusionPENG block is a good method in hip fractures analgesia and provides better analgesia than FICB. However, further studies with larger sample sizes are required to validate the efficacy and superiority of the PENG blocks over conventional techniques. Level of evidenceI.

Short Communication: Lumbar Plexus Block versus Suprainguinal Fascia Iliaca Block to Provide Analgesia Following Hip and Femur Surgery in Pediatric-Aged Patients – An Analysis of a Case Series

IntroductionFor surgical procedures involving the hip and femur, various regional anesthetic techniques may be used to provide analgesia. Although there has been an increase in the use of lumbar plexus block (LPB), the technique may be time consuming and associated with complications. Suprainguinal fascia iliaca compartment block (FICB) is a potentially easier and safer alternative. The current study prospectively compares LPB with suprainguinal FICB.MethodsThis prospective, double-blinded, randomized, study included patients undergoing elective orthopedic procedures of the hip and/or femur. All study patients received general anesthesia with randomization to either an LPB or suprainguinal FICB using 0.5% ropivacaine with epinephrine and dexamethasone. Postoperative pain control was achieved with intravenous hydromorphone delivered by patient-controlled analgesia with scheduled acetaminophen and ketorolac. Outcome data included time to perform the block, perioperative opioid consumption, postoperative pain scores (VAS) and hospital length of stay.ResultsThe study cohort included 15 patients between the ages of 7 and 16 years (LPB N = 7, FICB N = 8). The median block time was 6 minutes (IQR: 4.11) for the LPB group and 3 minutes (IQR: 3.6) for the FICB group (p = 0.107). Median postoperative pain scores were 4 (IQR: 0.6) for the LPB group and 2 (IQR: 0.5) for the FICB group (p = 0.032). There were no differences in the intraoperative or postoperative opioid and NSAID use between the two groups.DiscussionThe suprainguinal FICB provides analgesia that is at least as effective as a LPB following hip and femur surgery. Time to perform the block was shorter with the FICB due to the supine patient position and limited needle trajectory. Although we noted no adverse effects, the superficial needle trajectory of the FICB offers a less invasive approach and the potential for decreased risks of adverse effects.