Fascia Iliaca Research Articles

Automatic Segmentation and Probe Guidance for Real-Time Assistance of Ultrasound-Guided Femoral Nerve Blocks

Ultrasound-guided regional anesthesia can be challenging, especially for inexperienced physicians. The goal of the proposed methods is to create a system that can assist a user in performing ultrasound-guided femoral nerve blocks. The system indicates in which direction the user should move the ultrasound probe to investigate the region of interest and to reach the target site for needle insertion. Additionally, the system provides automatic real-time segmentation of the femoral artery, the femoral nerve and the two layers fascia lata and fascia iliaca. This aids in interpretation of the 2-D ultrasound images and the surrounding anatomy in 3-D. The system was evaluated on 24 ultrasound acquisitions of both legs from six subjects. The estimated target site for needle insertion and the segmentations were compared with those of an expert anesthesiologist. Average target distance was 8.5 mm with a standard deviation of 2.5 mm. The mean absolute differences of the femoral nerve and the fascia segmentations were about 1–3 mm.

Pre-operative lumbar plexus block provides superior post-operative analgesia when compared with fascia iliaca block or general anesthesia alone in hip arthroscopy.

The objective of this study is to retrospectively examine the effects of pre-operative fascia iliaca (FI) and lumbar plexus (LPB) nerve blocks on post-operative pain and secondary post-operative variables following arthroscopic surgery of the hip. Subjects undergoing arthroscopic surgery of the hip received one of three pre-operative anesthetic techniques; general anesthesia only, general anesthesia with FI or general anesthesia with LPB. Patient reported pain scores (0–10) were recorded at 0, 30, 60, 90 and 120 min after admission to the post-anesthesia care unit (PACU). Secondary variables examined include time spent in the PACU, morphine equivalent administered, presence of nausea, persistent numbness, parasthesia, weakness, increased narcotic usage for rebound pain, ED visits and hospital admissions. The mean pain scores over all time points were significantly lower in the LPB group (2.38) than the FI group (4.08, P < 0.001) and the Gen group (3.55, P < 0.001). Patients receiving a lumbar plexus block exhibited significantly decreased pain at t = 0 (P = 0.019), t = 30 (P = 0.038), t = 60 (P = 0.013), t = 90 (P = 0.017) and t = 120 (P = 0.001) after admission to PACU. The FI group showed no improvement in any post-operative variable when compared with general anesthesia alone. There was no difference in the time to discharge or in morphine equivalent administered between groups. One patient receiving a lumbar plexus block experienced a seizure lasting about 10 s. However, there were no medium or long-term complications. Lumbar plexus block administered in concert with general anesthesia provides clinically important and statistically significant post-operative pain relief when compared with general anesthesia alone or general anesthesia plus fascia iliaca block.

Assessing the Anatomical Variability of Deep Circumflex Iliac Vessels in Harvesting of Iliac Crest-Free Flap for Mandibular Reconstruction.

In this study, the authors' aims were to measure the length and location of branching of the pedicle from iliac artery, to describe the anatomical variability of iliac crest free flap with deep circumflex iliac (DCI) artery pedicle. Fourteen patients with ameloblastoma, osteosarcoma, and squamous cell carcinoma underwent mandibular resection and iliac crest-free flap reconstruction in one-step surgery. During surgery and before harvesting the deep circumflex iliac artery vascular pedicle, the location, origin, and the branching pattern of the pedicles were studied. Then, the pedicle length was measured and the data was analyzed using χ and independent samples t test. In all patients, the DCI vascular pedicles were separated with a common trunk from the external iliac artery and vein and the DCI arteries were posterior and lateral to the veins. Also after branching from the external iliac artery, all vascular DCI pedicles traveled upward and medially along the Iliacus muscle and the iliac fascia. The mean pedicle length was 21.78 mm for men and 19 mm for women. No statistically significant relationship was observed between the patient's age and the vascular pedicle length or number of branches. There are great variations in the anatomy of this vascular pedicle. According to the finding of this study, the length of the vascular pedicle is 2.78 mm higher in men which might help to increase the feasibility and success rate of this operation. No significant correlation was found between other variables.

High Opening Injection Pressure Is Associated With Needle-Nerve and Needle-Fascia Contact During Femoral Nerve Block.

High opening injection pressures (OIPs) have been shown to predict sustained needle tip contact with the roots of the brachial plexus. Such roots have a uniquely high ratio of fascicular versus connective tissue. It is unknown if this relationship is preserved during multifascicular nerve blockade. We hypothesized that OIP can predict needle-nerve contact during femoral nerve block, as well as detect needle contact with the fascia iliaca. Twenty adults scheduled for femoral block were recruited. Using ultrasound, a 22-gauge needle was sequentially placed in 4 locations: indenting the fascia iliaca, advanced through the fascia iliaca while lateral to the nerve, slightly indenting the femoral nerve, and withdrawn from the nerve 1 mm. At each location, the OIP required to initiate an injection of 1 mL D5W (5% dextrose in water) at 10 mL/min was recorded. Blinded investigators performed evaluations and aborted injections when an OIP of 15 psi was reached. Opening injection pressure was 15 psi or greater for 90% and 100% of cases when the needle indented the femoral nerve and fascia iliaca, respectively. Opening injection pressure was less than 15 psi for all 20 patients when the needle was withdrawn 1 mm from the nerve as well as at the subfascial position (McNemar χ2 P < 0.001). Opening injection pressure greater than 15 psi was associated with a block needle tip position slightly indenting the epineurium of the femoral nerve (90%) and the fascia iliaca (100%). Needle tip positions not indenting these structures were associated with OIP of less than 15 psi (100%).

Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve

Study objectiveThe femoral, lateral femoral cutaneous, and obturator nerves (ONs) can reportedly be blocked using a single-injection deep to the fascia iliaca (FI) at the level of the inguinal ligament. Two commonly used methods (the FI compartment and 3-in-1 blocks) have produced inconsistent results with respect to local anesthetic distribution and effect on the ON. To date, no study of either method has been performed using advanced imaging techniques to document both needle placement and local anesthetic distribution. We report the outcome of a series of 3-in-1 and FI blocks performed using ultrasound to guide needle position and magnetic resonance imaging (MRI) to define local anesthetic distribution. DesignPatients were prospectively studied, and images were interpreted using a randomized and blinded protocol. SettingThe study was performed in the perioperative area of an academic orthopedic specialty hospital. PatientsTen patients (ASA 1-2) having anterior cruciate ligament reconstruction received either 3-in-1 or FI compartment blocks for postoperative analgesia using the surface landmarks described for these techniques. InterventionsUltrasound was used to position the injecting needle immediately deep to the FI. Local anesthetic distribution was studied using MRI. MeasurementsPatients were examined for motor and/or sensory function of the femoral, obturator, and lateral femoral cutaneous nerves. Magnetic resonance imaging was used to document the limits of injectate distribution. Main resultsMagnetic resonance imaging showed distribution of injectate over the surface of the iliacus and psoas muscles to the level of the retroperitoneum. No patient showed medial extension of injectate to the ON. At the level of the inguinal ligament, injectate extended laterally toward the anterior superior iliac spine and medially to the femoral vein. All patients had significant weakness with extension of the knee and sensory loss over the anterior, lateral, and medial thigh. No patient demonstrated decreased hip adductor strength. ConclusionsUltrasound and MRI show consistent superior extension of local anesthetic to the level of the retroperitoneum for both techniques. There was reliable clinical effect on the femoral and lateral femoral cutaneous nerves. However, none of the injections produced evidence of ON block either at the level of the retroperitoneum or the inguinal ligament.

The clinical application progress of pediatric fascia iliaca compartment block

Fascia iliaca compartment block is described for blocking the femoral, lateral cutaneous, and obturator nerves if the local anesthetic is introduced behind the fascia iliaca, which circumscribes a potential space which contains three nevers.In recent years, an increasing number of fascia iliaca compartment blocks are performed in children with the development of the pediatric peripheral nerve block, and the analgesia effect on the thighs, hips and knees is satisfactory.In combination with the anatomy of the fascia iliaca compartment, this paper reviews the indications, methods and effect of fascia iliaca compartment block in children. Key words: Fascia; Nerve block; Anesthetics; Children

Fascia iliaca compartment block in the operation of children with femur fractures

Objective To investigate the effect of fascia iliaca compartment nerve block (FICB) to early analgesia and emergence agitation for children after the operation of femur fractures, and compare with fentanyl. Methods Totally 36 cases of children, which scheduled for the one-sided femur fractures surgery were selected after the approval from the Institutional Review Board of the hospital. They were randomly divided into two groups: FI group (FICB group) and FE group (Intravenous fentanyl group). Patients in both groups were received ultrasound guided FICB immediately after the induction of general anesthesia, 1 ml/kg ropivacaine (Naropin) was given in the FI group and 1 ml/kg saline in the FE group, sevoflurane was used for the anesthesia maintenance and 1 μg/kg intravenous fentanyl in FE group, instead of the same volume saline in FI group at 10 min before the surgery finished, and patients were sent to postanesthesia care unit (PACU) after extubation. Keep a record of the duration of the operation and extubation, the pain scores and the Pediatric Agitation and Emergence Delirium (PAED) scores were recorded at just arrived at PACU (T0), 10 min (T1), and 20 min (T3) after PACU, also included the duration in PACU and the postoperatively side effects. Results At the time of T0 and T1, the pain scores in FI group was significantly lower than the FE(P 0.05), but it was still lower in FI group from the age of 8 to 14(P<0.05); The PAED scores at the three time points were always lower in FI group when it was compared with FE group; the same trend occurred for the duration of extubation and PACU(P<0.05). Conclusions FICB can effectively reduce emergence agitation and the pain scores for the children undergoing the surgery of femur fractures during the early time after the operation, which is better than the intravenous fentanyl. Key words: Nerve block/MT; Fascia/SU; Ilium; Femoral fractures/SU; Analgesia

Successful Ultrasound-Guided Femoral Nerve Blockade and Catheterization in a Patient with Von Willebrand Disease.

Peripheral nerve blockade (PNB) is superior to neuraxial anesthesia and/or opioid therapy for perioperative analgesia in total knee replacement (TKR). Evidence on the safety of PNB in patients with coagulopathy is lacking. We describe the first documented account of continuous femoral PNB for perioperative analgesia in a patient with Von Willebrand Disease (vWD). Given her history of opioid tolerance and after an informative discussion, a continuous femoral PNB was planned for in this 34-year-old female undergoing TKR. A Humate-P intravenous infusion was started and the patient was positioned supinely. Using sterile technique with ultrasound guidance, a Contiplex 18 Gauge Tuohy needle was advanced in plane through the fascia iliaca towards the femoral nerve. A nerve catheter was threaded through the needle and secured without complications. Postoperatively, a levobupivacaine femoral catheter infusion was maintained, and twice daily Humate-P intravenous infusions were administered for 48 hours; enoxaparin thromboprophylaxis was initiated thereafter. The patient was discharged uneventfully on postoperative day 4. Given documentation of delayed, unheralded bleeding from PNB in coagulopathic patients, we recommend individualized PNB in vWD patients. Multidisciplinary team involvement is required to guide factor supplementation and thromboprophylaxis, as is close follow-up to elicit signs of bleeding throughout the delayed postoperative period.

Two Femoral Nerve Block Techniques Compared for Patients with Femur Fractures

Both the 3-in-1 block and fascia iliaca block (FIB) provide effective analgesia for patients with femoral neck fractures; however, they have never been directly compared in the emergency department setting. To test this, researchers in the U.K. randomized 178 adult patients …

Efficacy of fascia iliaca compartment block with dexmedetomidine combined with ropivacaine for analgesia in patients suffering from proximal femoral fractures

Objective To evaluate the efficacy of fascia iliaca compartment block with dexmedetomidine combined with ropivacaine for analgesia in the patients suffering from proximal femoral fractures.Methods Eighty emergency patients with proximal femoral fractures,aged 25-70yr,weighing 55-82 kg,of ASA physical status Ⅰ-[Ⅲ,were equally and randomly divided into 2 groups using a random number table:ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR).All the patients underwent fascia iliaca compartment block described by Dalens.0.4％ ropivacaine 30 ml was injected in group R,and 1 μg/kg dexmedetomidine 30 ml containing 0.4 ％ ropivacaine was injected in group DR.The severity of pain was assessed by VAS scores,and the level of sedation was assessed by Ramsay scores.At 30,60,90 and 120 min after injection (T1-4),VAS scores at rest and during activity were recorded,the effective analgesia (VAS scores at rest and during activity≤6) and satisfactory sedation (Ramsay scores 2-4) in group DR were also recorded,and the development of hemorrhage or hematoma at the puncture site,local anesthetic poisoning,adverse cardiovascular events and over-sedation was also recorded.Results Compared with group R,the rate of effective analgesia during activity was significantly increased at T2-4,and no significant change was found in the rate of effective analgesia at rest in group DR.In group DR,the rate of satisfactory sedation was 73 ％,88％,95％ and 95％ at T1-4,respectively,and no over-sedation occurred.No patients developed hemorrhage or hematoma at the puncture site,or local anesthetic poisoning in the two groups.Conclusion Fascia iliaca compartment block with 1 μg/kg dexmedetomidine combined with 4％ ropivacaine 30 ml can alleviate the early pain caused by passive activity without inducing obvious adverse reactions in the patients suffering from proximal femoral fractures. Key words: Dexmedetomidine ; Amides ; Nerve block ; Analgesia

A proposed novel function of the psoas minor revealed through cadaver dissection

There is sparse information about the anatomy and function of the psoas minor, specifically the extent and frequency to which the muscle attaches into the iliac fascia that drapes over the iliopsoas. This information may help clarify the function of the psoas minor, especially regarding the possibility of controlling the position and mechanical stability of the underlying iliopsoas. This descriptive, semiquantitative cadaveric study sought to clarify the gross anatomic detail of the psoas minor, particularly the muscle's distal attachments. Thirty-two embalmed cadaver hips were examined. Hips that presented with a psoas minor underwent further anatomic measurements. The psoas minor was present in 65.6% of the 32 hips. All of the psoas minor tendons attached firmly into iliac fascia, while 90.5% also had a firm bony attachment to the pelvis. On average, the muscle belly occupied the proximal 37.5 ± 6.0% of the entire musculotendinous unit, while the muscle belly's average anatomical cross-sectional area was 52.5 ± 34.3 mm(2) . The psoas minor's firm and consistent distal tendinous attachment into the iliac fascia may allow this muscle to partially control the position and mechanical stability of the underlying iliopsoas as it crosses the femoral head and adjacent regions. This hypothesized function may be clinically related to inflammation and pathology involving the iliopsoas tendon and adjacent tissues in the anterior region of the hip. Further study is now warranted to determine the clinical relevancy and biomechanical validity of this proposed function of the psoas minor.

Efficacy of continuous fascia iliaca compartment block with different concentrations of ropivacaine for postoperative analgesia in patients undergoing total hip arthroplasty

Objective To investigate the efficacy of continuous fascia iliaca compartment block withdifferent concentrations of ropivacaine for postoperative analgesia in patients undergoing total hip arthroplasty.Methods One hundred and sixty ASA physical status Ⅰ or Ⅲ patients,aged 52-84 yr,body mass index 18-26 kg/m2,scheduled for total hip arthroplasty,were randomly divided into 4 groups (n =40 each) using a random number table:0.20％ ropivacaine group (group A),0.25％ ropivacaine group (group B),0.30％ ropivacaine group (group C) and 0.35％ ropivacaine group (group D).A catheter was inserted into the fascia iliaca compartment on the affected side within 30 min after operation.The corresponding concentrations of ropivacaine 20 ml were given in each group.The catheter was then connected to a patient-controlled analgesia pump programmed to deliver 10 ml with a lockout interval of 60 rin for postoperative analgesia (72 h).When VAS score at rest≥4,parecoxib sodium 40 mg was injected intravenously.At 12,24,48 and 72 h of blockade,the passive and active exercise VAS scores were recorded.The consumption of ropivacaine within 72 h after the end of blockade,and requirement for parecoxib sodium and development of adverse reactions during blockade were recorded.Results Compared with group A,the passive and active exercise VAS scores were significantly decreased in C and D groups (P ＜ 0.05),and no significant change was found in group B (P ＞ 0.05),and the consumption of ropivacaine within 72 h after the end of blockade was significantly decreased in B,C and D groups (P ＜ 0.05).There was no significant difference in the passive and active exercise VAS scores between group C and group D (P ＞ 0.05).There was no significant difference in consumption of ropivacaine within 72 h after the end of blockade between B,C and D groups (P ＞ 0.05).There were no significant differences in the requirement for parecoxib sodium and incidence of vomiting among the four groups (P ＞ 0.05).Conclusion The optimum concentration of ropivacaine is 0.30％ when used for continuous fascia iliaca compartment block in patients undergoing total hip arthroplasty. Key words: Amides ; Fascia; Nerve block ; Arthroplasty, hip, replacement ; Analgesia

Pharmacological Treatments of Non-Substance-Withdrawal Delirium: A Systematic Review of Prospective Trials

Most reviews of pharmacological strategies for delirium treatment evaluate the effectiveness of these interventions for delirium prevention, reduction in duration and severity of ongoing delirium, and other outcomes that extend beyond the recommendations of expert treatment guidelines. However, little if any attention is given to substantiating the potential benefits of such treatment or addressing the methodological weaknesses that, in part, limit the pharmacological recommendations made by expert treatment guidelines. Therefore, the authors conducted a systematic review to provide the most up-to-date and inclusive review of published prospective trials of potential pharmacological interventions for the prevention and treatment of delirium, and they discuss potential benefits of pharmacological prevention of delirium and/or reduction of ongoing delirium episode duration and severity. The analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including prospective randomized and nonrandomized double-blind, single-blind, and open-label clinical trials of any pharmacological agent for the prevention or treatment of delirium and reviewing them systematically for effectiveness on several predefined outcomes. The pharmacological strategies reviewed showed greater success in preventing delirium than in treating it. Significant delirium prevention effects are associated with haloperidol, second-generation antipsychotics, iliac fascia block, gabapentin, melatonin, lower levels of intraoperative propofol sedation, and a single dose of ketamine during anesthetic induction and with dexmedetomidine compared with other sedation strategies for mechanically ventilated patients. These promising results warrant further study with consideration of the methodological weaknesses and inconsistencies of studies to date.

Ultrasound guidance of needle tip position for femoral nerve blockade

The femoral nerve lies in the ilio-fascial space in a groove formed by the iliac and psoas muscles (GIPM) posteriorly, and overlaid by the iliac fascia. Recommendations for needle insertion for femoral blockade using ultrasound imaging are to insert the needle tip behind the iliac fascia at the lateral side of the femoral nerve, but this part of the nerve is poorly visualised in some patients. A more accurate location of the lateral part of the femoral nerve might be achieved by identifying the GIPM and its lateral segment. The objectives of this study are to determine the frequency of ultrasound visibility of the lateral part of the femoral nerve and GIPM, and to note the motor response to electrostimulation of the nerve and the spread of local anaesthetic when positioning the needle tip at the lateral segment of the GIPM. A prospective observational (case series) study. Department of Anaesthesiology of a University Hospital. Inpatients undergoing hip or knee surgery scheduled to have femoral nerve blockade were eligible to participate. The ultrasound probe was positioned in the inguinal region, and direct ultrasound identification of the femoral nerve, lying on the GIPM behind the iliac fascia, was obtained. A stimulating needle, inserted in-plane and advanced lateral to medial was directed towards the femoral nerve until it made contact with the target structure defined as the lateral segment of the GIPM. Ultrasound identification of the lateral part of the femoral nerve and GIPM. An image compatible with the lateral part of the femoral nerve was observed in 91 out of 100 patients. In the remaining nine patients, when the lateral part of the femoral nerve was not seen, GIPM could be visualised in five (55%) patients. The iliac fascia and GIPM were clearly visualised in 68 and 85 patients respectively. In 85 cases when the needle tip was placed at the lateral segment of GIPM, a quadriceps femoris muscle motor response was obtained, and the distribution of the anaesthetic solution was observed behind the iliac fascia in all patients. In two patients, only the iliac fascia was identified, and in the two patients, none of these structures was correctly visualised. The GIPM was seen in the majority undergoing ultrasound-guided femoral nerve blockade, even when the lateral part of the femoral nerve was not visualised. Using the lateral segment of GIPM as a target for needle tip location in an in-plane lateral to medial approach of the femoral nerve deserves further investigation.

Combination of Fascia Iliaca Compartment Block on the Surgical Side with Sacral Spinal Anesthesia for Hip to Knee Surgery

Background and Aims: Different kinds of adjutants are used with local anesthetics during intrathecal procedure for prolongation of action. However, they are not completely free from side effects like postoperative hypoxia and cardiovascular instability. But subsequently, the use of preoperative femoral nerve block on surgical side provides beneficial analgesia to relieve fracture pain before operation, to make cooperative during administration of spinal anesthesia, to act as adjutants to intrathecal procedure and lastly to provide postoperative analgesia without side effect like central depression. Method: 50 (fifty) patients were administered fascia iliac compartment block (FICB) on the surgical side before intrathecal procedure with 30 ml of 0.5% injection ropivacaine. Sacral spinal anesthesia was administered through the first or second dorsal foramen of sacrum with 3 ml of 0.5% injection bupivacaine. Periodically, the estimation of blood pressure, heart rate and oxygen concentration was carried out. Results: 50 (fifty) patients were administered FICB successfully on surgical side preoperatively. Pain at the fractured site was relieved completely and all patients cooperated at the time of intrathecal procedure. Hemodynamic fluctuation was absent in operative period. Prolonged analgesia was noticed in postoperative period. Conclusion: High quality of analgesia, delivered by FICB is appropriate to relieve the pain in preoperative period from fractured site, to act as an adjutant to sacral spinal anesthesia during surgery and to provide prolonged analgesia after surgery without adverse reaction like hypoxia and central depression to combat surgical stress response.

Accuracy of loss of resistance technique for location of fascia iliaca compartment : evaluation using ultrasound technique

Objective The evaluate the accuracy of loss of resistance technique for location of fascia iliaca compartment using ultrasound technique.Methods One hundred and seventy-five patients undergoing hip surgery were enrolled in the study.A line was drawn on the skin from the pubic tubercle to the anterior superior iliac spine and divided in three equal parts.The site of puncture was marked 2 cm distal to the point at which the lateral met the middle third of the line.The needle was inserted until a loss of resistance was felt twice (fascia lata and fascia iliaca),at which point 0.5 ％ ropivacaine 30 ml was infused.Correct puncture was identified by visualized spread of local anesthetic solution under the guidance of ultrasound technique.The effective sensory block was recorded within 20 min after administration.Results The accuracy of loss of resistance method for locating the fascia iliac compartment was 56.6 ％ using ultrasound technique.There were 80 patients in whom fault site of puncture occurred:25 cases in the superficial layer of the fascia iliac and 51 cases in the iliopsoas muscle.The rate of effective block was 98.0 ％ for correct location and 82.9 ％ for fault location.Conclusion Loss of resistance technique cannot accurately locate the fascia iliac compartment. Key words: Nerve block ; Punctures ; Ultrasonography

Fascia lliaca Block for Analgesia After Hip Arthroplasty

Fascia iliaca block (FIB) is often used to treat pain after total hip arthroplasty (THA), despite a lack of randomized trials to evaluate its efficacy for this indication. The objective of this study was to assess the analgesic benefit of FIB after THA. Our primary hypothesis was administration of FIB decreases the intensity of postoperative pain (numeric rating scale [NRS-11] score) compared with sham block (SB) in patients after THA. After institutional review board approval and informed consent, 32 eligible patients having THA were recruited. In the postoperative care unit, although all patients received intravenous morphine sulfate patient-controlled analgesia, patients reporting pain of 3 or greater on the NRS-11 scale were randomized to receive ultrasound-guided fascia iliaca (30 mL 0.5% ropivacaine) or SB (30 mL 0.9% NaCl) using identical technique, below fascia iliaca. The primary outcome was pain intensity (NRS-11) after FIB. Thirty-two patients (16 in each group) completed the study; all patients received an FIB. There was no difference in pain intensity (NRS-11 = 5.0 ± 0.6 vs 4.7 ± 0.6, respectively) after FIB versus SB or in opioid consumption (8.97 ± 1.6 vs 5.7 ± 1.6 mg morphine, respectively) between the groups at 1 hour. The morphine consumption after 24 hours was similar in both groups (49.0 ± 29.9 vs 50.4 ± 34.5 mg, P = 0.88, respectively). The evidence in these data suggests that the difference in average pain intensity after FIB versus SB was not significant (95% confidence interval, -2.2-1.4 NRS units).

“Fascia Iliaca Block for Analgesia After Hip Arthroplasty

“Fascia Iliaca Block for Analgesia After Hip Arthroplasty

Magnesium prolongs the duration of analgesia after a bupivacaine fascia iliaca compartment block

Background A fascia iliaca compartment block (FICB) performed in patients with hip fracture before spinal anesthesia can help facilitate patients’ positioning and reduce the postoperative analgesic requirements; however, the duration of FICB is limited to the early postoperative period. Magnesium has been shown to prolong the duration of analgesia when coadministered with local anesthetics for peripheral nerve blockade. Objectives To determine the effect of the addition of magnesium sulfate to bupivacaine on the duration of analgesia provided by FICB in patients undergoing surgery hip fracture. Methods Forty-four patients (50–79 years old) scheduled for hip fracture repair were randomized to either group B, which received FICB with 30 ml bupivacaine 0.25%, or group MB, which received FICB with 30 ml bupivacaine 0.25% containing 250 mg magnesium sulfate. Sensory blockade in the anterior thigh (supplied by the femoral nerve) and pain scores at rest and on movement were assessed 30 min after FICB. Then, the patients were transferred to the operating room, instructed to sit for spinal anesthesia, and satisfaction with the sitting position was recorded (yes/no). Postoperatively, pain scores at rest and on movement at 4, 8, 12, and 24 h after FICB, time to first analgesic requirement, total tramadol given in the first 24 h after FICB, and the occurrence of adverse effects were also recorded and compared between the two groups. Results Patients who received magnesium had a longer time to first analgesic administration, lower pain scores on movement at 8, 12, and 24 h after the FICB, and lower tramadol consumption for postoperative pain. No complications related to FICB were reported. Conclusion The addition of magnesium to bupivacaine for FICB significantly prolongs the duration of analgesia and reduces opioid demand, without side effects.

Neurolysis for Megalgia Paresthetica

ObjectiveMeralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue.MethodsDuring the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted.ResultsTwelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported.ConclusionNeurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.