Femoral Nerve Block Group Research Articles

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.

A Comparative Study between Sub-sartorial Canal Block and Femoral Nerve Block for Postoperative Analgesia after Arthroscopic Knee Surgery

Abstract Background Knee arthroscopy is a common orthopedic procedure worldwide, despite its minimally invasive nature compared to the traditional knee surgery, post-arthroscopic pain may be severe, and the patients generally require a significant amount of opioid-based analgesics after such procedures. Femoral nerve block (FNB) is commonly used for analgesia inpatients undergoing knee or ankle surgery. Aim of the Work The aim of the study is to compare the analgesic efficacy and functional recovery of ACB and FNB in patients who have undergone knee arthroscopy. Patients and Methods In the period from April 2021 to October 2021 sixty patients who underwent Arthroscopic knee surgery were randomly allocated to one of two groups and comparative study was done. Group I (group FNB): patients received Femoral Nerve Block (FNB) after spinal anaesthesia, group II (group ACB): Patients received Sub-sartorial canal block (Adductor Canal Block) (ACB) after spinal anaesthesia. After the end of the surgery, the femoral nerve block or adductor canal block will be performed according to patient group allocation. Results During our study, it was found that ACB is equally effective with FNB in patient satisfaction for post operative analgesia (NRS at 4 hrs, 8 hrs, 12 hrs, 16 hrs, 20 hrs and 24 hrs was non-significant as P value was 0.3, 0.29, 0.1, 0.5, 0.35, 0.87 respectively) but ACB is more effective than FNB in post operative ambulation and rehabilitation after arthroscopic knee surgery (ACB ambulated after 180.7 ± 23.6 mins in ACB and 241.2 ± 29.12 mins in FNB with pvalue <0.001). Numerous studies compared adductor canal block with femoral nerve block in motor power and analgesia. Conclusion Our study concluded that Adductor Canal Block is more effective than Femoral Nerve Block in post operative ambulation and equally effective with Femoral nerve block in patient satisfaction for post operative analgesia after arthroscopic knee surgery.

Comparison between Ultrasound Guided Femoral Nerve Block versus IPACK Block in Patients Undergoing Total Knee Replacement on Postoperative Ambulation and Pain: A randomised controlled clinical trial

Background: Total knee replacement (TKR) is a widely used surgical technique for knee disorders. The study is aimed to assess the interspace between the popliteal artery and capsule of the posterior knee (IPACK) block concerning postoperative ambulation as a primary outcome and analgesic efficacy as a secondary outcome when compared to the femoral nerve block (FNB) following TKR. Methods: Under spinal anaesthesia, forty patients undergoing elective unilateral TKR were divided into two groups: FNB, receiving ultrasound-guided FNB, and IPACK Block, receiving ultrasound-guided IPACK block. Ambulation was assessed with the timed up-and-go (TUG) and 10-meter walk tests. Post-surgery, pethidine consumption in 24 hours and VAS scores were recorded. Results: After 24 hours postoperative, TUG showed a mean value of 4.8±1.2 seconds in the IPACK group compared with 8.7±2.1 seconds in the FNB group (p < 0.001). The time needed for a 10-meter walk test was significantly longer in the FNB group (12.1±2.1 seconds) than in the IPACK group (8.3±1.2 seconds) in the first 12 hours postoperative. Similarly, 24 hours postoperatively, values were 6.4±1.2 seconds Vs 10.4±2.1 seconds respectively (p < 0.001). Using the VAS score, the FNB group demonstrated a greater analgesic effect than the IPACK group, while taking less total pethidine (73.8±17.2 mg) compared to 110.0±29.7 mg in the IBACK group. Conclusion: There was delayed ambulation in FNB than in IPACK. The FNB has a better analgesic profile compared to the IPACK block with less total analgesics consumption over 24 hours post-operatively.

Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block, and Adductor Block After Total Knee Arthroplasty: A Randomized Clinical Trial.

This study aimed to compare the analgesic effects of continuous femoral nerve block (FNB), femoral triangle block (FTB), and adductor canal block (ACB) following total knee arthroplasty (TKA). The goal was to identify the most effective nerve block technique among these. Patients undergoing TKA were randomly assigned to 1 of 3 groups: FNB, FTB, or ACB. Nerve blocks were administered preoperatively, with catheters placed for patient-controlled nerve analgesia (PCNA). The primary end point was the Numeric Rating Scale (NRS) score at movement at 24 hours postsurgery. Secondary end points included NRS scores at rest and movement, quadriceps strength, Timed Up and Go (TUG) test performance, range of motion, effective PCNA utilization, and opioid consumption at various postsurgery time points. Of the 94 valid data sets analyzed (FNB: 31, FTB: 31, ACB: 32), significant differences were observed in the primary end point (H=7.003, P =0.03). Post hoc analysis with Bonferroni correction showed that the FNB group had a significantly lower median pain score (3 [2 to 4]) compared with the ACB group (4 [3 to 5], Bonferroni-adjusted P =0.03). Regarding secondary end points, both the FNB and FTB groups had significantly lower NRS scores than the ACB group at various time points after surgery. Quadriceps strength and TUG completion were better in the FTB and ACB groups. There were no statistically significant differences among the groups for the other end points. Continuous FTB provides postoperative analgesia comparable to FNB but with the advantage of significantly less impact on quadriceps muscle strength, a benefit not seen with FNB. Both FTB and ACB are effective in preserving quadriceps strength postoperatively.

Periarticular cocktail injection is more useful than nerve blocks for pain management after anterior cruciate ligament reconstruction

BackgroundAnterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction. MethodsThis retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a t-test. ResultsThere were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008). ConclusionsFollowing ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations.

Triple injection peri-sartorius (TIPS) block for postoperative analgesia after total knee arthroplasty: Randomised controlled study.

Motor-sparing analgesia after total knee arthroplasty (TKA) is crucial. The primary endpoint was the postoperative visual analogue scale (VAS) score after triple injection peri-sartorius (TIPS) block after TKA. Secondary endpoints were postoperative morphine consumption, 24-h postoperative ambulation distances and the degrees of active knee extension. After general anaesthesia or spinal anaesthesia administration and before surgical incision, 80 patients undergoing TKA were randomised into group TIPS (received ultrasound-guided TIPS block where 40 ml 0.25% bupivacaine and 4 mg dexamethasone were injected: 10 ml at the distal femoral triangle, 10 ml above the sartorius and 20 ml at the distal adductor canal) and group FNB (femoral nerve block; received ultrasound-guided FNB with 20 ml 0.25% bupivacaine mixed with 4 mg dexamethasone). Postoperative pain score was noted and compared. Dynamic VAS scores were lower in the TIPS group than in FNB, while the resting VAS scores were not significantly different. Mean (standard deviation [SD]) postoperative morphine consumption was 5.82 (2.47) mg in the TIPS group (95% confidence interval [CI] 5.03,6.61) versus 9.87 (2.99) mg in the FNB group (95% CI 8.91,10.83). Ambulation distances and active postoperative knee extension in the TIPS group showed greater significance than in the FNB group (TIPS: 18.0 [7.37] m, 95% CI 15.64,20.35] vs. FNB: 8.95 [5.93] m, 95% CI 7.05,10.84) and (TIPS: 52.12 [16.39], 95% CI 46.88,57.33 vs. FNB: 26.05 [11.10], 95% CI 22.501,29.59). Nausea was more evident in FNB patients. TIPS block provides superior analgesia than FNB with motor sparing of the quadriceps after TKA.

Analgesic efficacy of local infiltration anaesthesia versus femoral nerve block in alleviating postoperative wound pain following total knee arthroplasty: A systematic review and meta-analysis.

Total knee arthroplasty (TKA) often involves significant postoperative pain, necessitating effective analgesia. This meta-analysis compares the analgesic efficacy of local infiltration anaesthesia (LIA) and femoral nerve block (FNB) in managing postoperative wound pain following TKA. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis was structured around the PICO framework, assessing studies that directly compared LIA and FNB in TKA patients. A comprehensive search across PubMed, Embase, Web of Science and the Cochrane Library was conducted without time restrictions. Studies were included based on specific criteria such as participant demographics, study design and outcomes like pain scores and opioid consumption. Quality assessment utilized the Cochrane Collaboration's risk of bias tool. The statistical approach was determined based on heterogeneity, with the choice of fixed- or random-effects models guided by the I2 statistic. Sensitivity analysis and evaluation of publication bias using funnel plots and Egger's linear regression test were also conducted. From an initial pool of 1275 articles, eight studies met the inclusion criteria. These studies conducted in various countries from 2007 to 2016. The meta-analysis showed no significant difference in resting and movement-related Visual Analogue Scale scores post-TKA between the LIA and FNB groups. However, LIA was associated with significantly lower opioid consumption. The quality assessment revealed a low risk of bias in most studies, and the sensitivity analysis confirmed the stability of these findings. There was no significant publication bias detected. Both LIA and FNB are effective in controlling postoperative pain in TKA patients, but LIA offers the advantage of lower opioid consumption. Its simplicity, cost-effectiveness and opioid-sparing nature make LIA the recommended choice for postoperative analgesia in knee replacement surgeries.

Comparison of the Effects of Adductor Canal and Femoral Nerve Blocks on Postoperative Opioid Consumption and Inflammatory Factor Levels in Elderly Patients After Total Knee Arthroplasty: A Prospective Observational Study.

Total Knee Arthroplasty (TKA) is a highly invasive procedure causing severe postoperative pain, which hampers early mobility. Effective pain management is crucial for optimal recovery. This study aimed to evaluate how adductor canal block (ACB) and femoral nerve block (FNB) affect opioid use and inflammation factor levels in elderly TKA patients. This prospective observational study included 120 patients who received TKA, and divided them into three groups, based on the different nerve block technique: ACB, FNB, and no intervention before general anesthesia (CON). Postoperative opioid consumption, pain assessment, inflammation factor, knee function recovery and other clinical indicators were recorded. The CON group had significantly higher cumulative sufentanil consumption compared to the ACB and FNB groups at both 12 h and 48h postoperative (P<0.001). Compared with the CON group, the ACB and FNB groups persistently had lower pain scores until 12 h at rest and 24 h during motion after surgery. The ACB group showed significantly lower serum concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) compared to the CON group at 24 h postoperative (P=0.017, P=0.009), and IL-6 levels remained significantly lower at 72 h postoperative (P=0.005). Both ACB and FNB groups achieved earlier ambulation compared to the CON group (P=0.002). On the first day postoperative, both the ACB and FNB groups showed significantly better knee motion (P<0.001), quadriceps strength (P<0.001), and daily mobilization (P<0.001) compared to the CON group. Additionally, the ACB group exhibited superior quadriceps strength (P<0.001) and daily mobilization (P<0.001) compared to the FNB group. The ACB and FNB groups exhibited comparable clinical efficacy outcomes in terms of pain scores and opioid consumption. However, the ACB group experienced reduced postoperative inflammation and improved knee recovery, especially in quadriceps strength.

Systemic Ropivacaine Concentrations Following Local Infiltration Analgesia and Femoral Nerve Block in Older Patients Undergoing Total Knee Arthroplasty.

The study examined the pharmacokinetic profile of fixed formulation mixtures comprising 225 mg of ropivacaine for local infiltration analgesia with or without epinephrine, and femoral nerve block in older patients presenting for orthopedic surgery and explored potential influences of block type, age, and body weight on this profile. Twenty four patients scheduled for total knee arthroplasty were randomly assigned to three groups: femoral nerve block, local infiltration analgesia with epinephrine and local infiltration analgesia without epinephrine. Blood samples were collected at 10, 30, 60, and 120 min following the block and total plasma concentrations of ropivacaine were quantified by high performance liquid chromatography. The mean individual peak total plasma concentrations of ropivacaine in local infiltration analgesia with and without epinephrine, and femoral nerve block group were 0.334, 0.490 and 0.545 μg mL-1 (p = 0.16). Local infiltration with epinephrine group had significantly lower plasma ropivacaine concentrations at 30, 60 and 120 minutes. The plasma ropivacaine concentrations exceeded 2.2 μg mL-1 in one patient. Age, but not body weight, had a moderate correlation with peak plasma ropivacaine concentration (r = 0.37, p = 0.08). Administration of a fixed 225 mg dose of ropivacaine for local infiltration analgesia with epinephrine and femoral nerve block results in plasma ropivacaine concentrations below the toxicity threshold, indicating their safety. The use of local infiltration analgesia with epinephrine provides a greater safety margin, as local infiltration analgesia without epinephrine may lead to ropivacaine concentrations associated with symptoms of local anesthetic toxicity.

A Comparison between Sub-Sartorial Canal Block and Femoral Nerve Block for Postoperative Analgesia after Arthroscopic Knee Surgery

Abstract Background Knee arthroscopy is a common orthopedic procedure worldwide, despite its minimally invasive nature compared to the traditional knee surgery, post-arthroscopic pain may be severe, and the patients generally require a significant amount of opioid-based analgesics after such procedures. Aim of the Work The aim of the study is to compare the analgesic efficacy and functional recovery of ACB and FNB in patients who have undergone knee arthroscopy. Patients and Methods In the period from April 2021 to October 2021 sixty patients who underwent Arthroscopic knee surgery were randomly allocated to one of two groups and comparative study was done. Group I (group FNB): (no. 30): Patients received Femoral Nerve Block (FNB) after spinal anaesthesia. Group II (group ACB): (no. 30): Patients received Sub-sartorial canal block (Adductor Canal Block) (ACB) after spinal anaesthesia. Results During our study, it was found that ACB is equally effective with FNB in patient satisfaction for post operative analgesia (NRS at 4 hrs, 8 hrs, 12 hrs, 16 hrs, 20 hrs and 24 hrs was non-significant as P value was 0.3, 0.29, 0.1, 0.5, 0.35, 0.87 respectively) but ACB is more effective than FNB in post operative ambulation and rehabilitation after arthroscopic knee surgery (ACB ambulated after 180.7 ± 23.6 mins in ACB and 241.2 ± 29.12 mins in FNB with pvalue &amp;lt;0.001). When compared to our study, it revealed that the group received FNB suffered from quadriceps weakness which interfered with postoperative rehabilitation and early ambulation although postoperative analgesia was equally effective in comparison to the group received ACB. Conclusion Our study concluded that Adductor Canal Block is more effective than Femoral Nerve Block in post operative ambulation and equally effective with femoral nerve block in patient satisfaction for post operative analgesia after arthroscopic knee surgery.

A comparative study of intravenous fentanyl and ultrasound-guided femoral nerve block for positioning during spinal anaesthesia in femur fracture surgeries

Objective: To assist in the administration of spinal anesthesia for patients undergoing femur fracture procedures, we conducted comparison research to compare the analgesic efficiency of intravenous fentanyl against ultrasound-guided femoral nerve block (FNB). Material and Methods: A group of 112 patients ranging in age from 18 to 70 years old who had ASA Physical Status I and II and were having femur fracture procedures under spinal anaesthesia participated in the randomised, prospective, interventional trial. These individuals were divided into two groups through a random assignment process. Group FENT (n = 56) received Intravenous fentanyl 1 microgram/kilogram (µg/kg) and five minutes before positioning for spinal anaesthetic, group FNB (n = 56) received ultrasound-guided FNB with 20 millilitres (ml), 1.5% lignocaine and adrenaline (1:200,000). Results: Comparison of pain scores during positioning using the Visual Analog Scale (VAS) revealed that Group FENT had a score of 1.95 ± 0.585, whereas Group FNB had a score of 0.61 ± 0.562 (p-value 0.001). The FNB group demonstrated superior patient positioning quality. Patient satisfaction was similar in both groups, and no significant side effects were observed. Conclusion: FNB offers enhanced analgesia, improved patient positioning, higher patient satisfaction, reduced reliance on additional analgesia, and fewer side effects compared to intravenous fentanyl for spinal anesthesia.

A comparative study of intravenous fentanyl and ultrasound-guided femoral nerve block for positioning during spinal anaesthesia in femur fracture surgeries

Objective: To assist in the administration of spinal anesthesia for patients undergoing femur fracture procedures, we conducted comparison research to compare the analgesic efficiency of intravenous fentanyl against ultrasound-guided femoral nerve block (FNB). Material and Methods: A group of 112 patients ranging in age from 18 to 70 years old who had ASA Physical Status I and II and were having femur fracture procedures under spinal anaesthesia participated in the randomised, prospective, interventional trial. These individuals were divided into two groups through a random assignment process. Group FENT (n = 56) received Intravenous fentanyl 1 microgram/kilogram (µg/kg) and five minutes before positioning for spinal anaesthetic, group FNB (n = 56) received ultrasound-guided FNB with 20 millilitres (ml), 1.5% lignocaine and adrenaline (1:200,000). Results: Comparison of pain scores during positioning using the Visual Analog Scale (VAS) revealed that Group FENT had a score of 1.95 ± 0.585, whereas Group FNB had a score of 0.61 ± 0.562 (p-value 0.001). The FNB group demonstrated superior patient positioning quality. Patient satisfaction was similar in both groups, and no significant side effects were observed. Conclusion: FNB offers enhanced analgesia, improved patient positioning, higher patient satisfaction, reduced reliance on additional analgesia, and fewer side effects compared to intravenous fentanyl for spinal anesthesia.

Efficacy of Anterior Quadratus Lumborum Block and Pain After Total Hip Arthroplasty: A Randomized Controlled Trial

BackgroundAnterior quadratus lumborum block (AQLB) is one of the compartment blocks and has recently attracted attention as a new method of analgesia for postoperative hip surgery analgesia. This study aimed to compare the analgesic efficacy of AQLB in patients undergoing primary total hip arthroplasty (THA). MethodsThere were 120 patients undergoing primary THA under general anesthesia randomly allocated to receive a femoral nerve block (FNB) or an AQLB. The primary outcome was total morphine consumption over the initial 24-hour postoperative period. Secondary outcomes included the pain score evaluation while at rest and during active and passive motion over the 2 days following surgery and the manual muscle testing of the quadriceps femoris. The numerical rating scale (NRS) score was used for evaluating the postoperative pain score. ResultsThere were no significant differences between the 2 groups concerning morphine consumption within 24 hours after surgery (P = .72). The NRS score at rest and passive motion were similar at all-time points (P > .05). However, there was a statistically significant difference in pain reported during the active motion for the FNB group compared to the AQLB (P = .04). No significant differences were found between the 2 groups concerning muscle weakness incidence. ConclusionBoth AQLB and FNB demonstrated adequate efficacy for postoperative analgesia at rest in THA. However, based on our study, whether AQLB is inferior or noninferior to FNB as an analgesic method for THA was inconclusive.

A randomized controlled trial of iliopsoas plane block vs. femoral nerve block for hip arthroplasty

BackgroundIliopsoas plane block (IPB) is a novel analgesic technique for hip surgery that retains quadriceps strength. However, evidence from randomized controlled trial is remains unavailable. We hypothesized that IPB, as a motor-sparing analgesic technique, could match the femoral nerve block (FNB) in pain management and morphine consumption, providing an advantage for earlier functional training in patients underwent hip arthroplasty.MethodsWe recruited ninety patients with femoral neck fracture, femoral head necrosis or hip osteoarthritis who were scheduled for unilateral primary hip arthroplasty were recruited and received either IPB or FNB. Primary outcome was the pain score during hip flexion at 4 h after surgery. Secondary outcomes included quadriceps strength and pain scores upon arrival at post anesthesia care unit (PACU) and at 2, 4, 6, 24, 48 h after surgery, the first time out of bed, total opioids consumption, patient satisfaction, and complications.ResultsThere was no significant difference in terms of pain score during hip flexion at 4 h after surgery between the IPB group and FNB group. The quadriceps strength of patients receiving IPB was superior to those receiving FNB upon arrival at PACU and at 2, 4, 6 and 24 h after surgery. The IPB group showed a shorter first time out of bed compared to the FNB group. However, there were no significant differences in terms of pain scores within 48 h after surgery, total opioids consumption, patient satisfaction and complications between the two groups.ConclusionIPB was not superior to FNB in terms of postoperative analgesia for hip arthroplasty. However, IPB could serve as an effective motor-sparing analgesic technique for hip arthroplasty, which would facilitate early recovery and rehabilitation. This makes IPB worth considering as an alternative to FNB.Trial registrationThe trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200055493; registration date: January 10, 2022; enrollment date: January 18, 2022; https://www.chictr.org.cn/searchprojEN.html).

Comparative study between surgical wound catheter, femoral nerve block, and adductor canal block for postoperative analgesia after knee arthroplasty: A double blind randomized clinical trial.

The present study compared the surgical wound catheter (SWC), femoral nerve block (FNB), and adductor canal block (ACB) for postoperative analgesia after knee arthroplasty. The study included (180) patients scheduled for unilateral total knee replacement and were randomly allocated into three groups. Patients received postoperative analgesia via continuous infusion of ropivacaine 0.2% (10 ml bolus followed by continuous infusion of 5 ml/hour) through the SWC, FNB, or ACB groups. All groups received supplemental analgesia by IV morphine using patient controlled analgesia. Pain scores were assessed at rest and during movements, the worst and least pain scores, and how often were in worst pain during the first 72 hours. The functional activity and patient's satisfaction were also recorded. The study showed significant reductions in pain scores at rest and during movements in all groups compared to the baseline scores. Significant reductions in pain scores were observed in both ACB and FNB groups compared to the SWC group (P < 0.05). The worst pain scores were (6.15 ± 2.9, 5.85 ± 2.7, and 5.025 ± 1.513), least pain scores (2.06 ± 0.72, 1.92 ± 1.34 and 1.89 ± 1.76), percentage of time in worst pain (17.67 ± 9.15, 11.42 ± 7.50, and 9.8.8 ± 8.14) and the total morphine consumption (39.24 ± 6.82, 34.55 ± 7.86, and 26.40 ± 8.47 mg) in the SWC, FNB, and ACB groups, respectively. Functional assessments and patient's satisfaction, at 6 and 24 hours, were significantly better in ACB followed by SWC, and lastly FNB group (P < 0.5). No significant differences in the incidence of side effects (P > 0.05). Local anesthetic leak from the SWC was a continuous concern by the orthopedic surgeons. In terms of efficiency, ACB provided the highest quality of analgesia in terms of pain relief, functional activity, and patient's satisfaction. Both ACB and FNB provided higher quality of analgesia compared to the SWC. While ACB and SWC provided better functional improvements compared to FNB.

Impact of femoral nerve block versus fascia iliaca block on postoperative pain control after hip arthroscopy: a prospective randomized trial

Background &amp; Objectives: Hip arthroscopy is a minimally invasive technique that has been widely used to treat a variety of hip joint diseases. However, severe postoperative pain usually follows these surgeries, necessitating the use of multimodal pain control strategies. Regional blocks like femoral nerve block (FNB) and fascia iliaca compartment block (FICB) allow for better postoperative analgesia while using less parenteral opioids. The purpose of this study was to evaluate and compare the efficacy of ultrasound guided FNB versus ultrasound guided FICB for postoperative analgesia. &#x0D; Methodology: A total of 60 patients, planned for hip arthroscopy, aged 21−65 y, of either sex and ASA I−II were randomly divided into two groups: Group FICB (n= 30), in which FICB with 40 mL levobupivacaine 0.25% was done after induction of general anesthesia (GA) and Group FNB (n = 30) in which FNB with 20 mL levobupivacaine 0.25% was done after induction of GA. Time to the first analgesic use was the primary outcome, whereas total pethidine consumption as rescue analgesic in the first 24 h postoperatively, VAS scores, and the assessment of postoperative early ambulation were the secondary outcomes.&#x0D; Results: Patients in the Group FICB experienced a significantly shorter time to ambulation compared to Group FNB; 17.2 ± 2.1 vs. 19.8 ± 2.1 h respectively (P &lt; 0.001). There were no significant differences between the two groups regarding time to first analgesic requirement (pethidine), total pethidine consumption, and the VAS scores. No cases of drug allergy were reported in both groups.&#x0D; Conclusion: Both fascia iliaca compartment block and femoral nerve block were effective in reducing postoperative pain; however, fascia iliaca compartment block was superior regarding early ambulation.&#x0D; Abbreviations: FNB: Femoral Nerve Block; FICB: Fascia Iliaca Compartment Block; GA: General Anesthesia; US: Ultrasound; VAS: Visual Analog Scale&#x0D; Key words: Hip arthroscopy; Fascia iliaca compartment block; Femoral Nerve Block; Pain; Pain Management; Postoperative pain&#x0D; Citation: Alasnsary AM, Elgouhary MO, Rashed MM, Ali MM. Impact of femoral nerve block versus fascia iliaca block on postoperative pain control after hip arthroscopy: a prospective randomized trial. Anaesth. pain intensive care 2022;27(1):23−30; DOI: 10.35975/apic.v27i1.2120&#x0D; Received: September 10, 2022; Reviewed: November 05, 2022; Accepted: November 16, 2022

Motor-Sparing Effect of Adductor Canal Block for Knee Analgesia: An Updated Review and a Subgroup Analysis of Randomized Controlled Trials Based on a Corrected Classification System.

Discrepancies in the definition of adductor canal block (ACB) lead to inconsistent results. To investigate the actual analgesic and motor-sparing effects of ACB by anatomically defining femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), we re-classified the previously claimed ACB approaches according to the ultrasound findings or descriptions in the corresponding published articles. A meta-analysis with subsequent subgroup analyses based on these corrected results was performed to examine the true impact of ACB on its analgesic effect and motor function (quadriceps muscle strength or mobilization ability). An optimal ACB technique was also suggested based on an updated review of evidence and ultrasound anatomy. We systematically searched studies describing the use of ACB for knee surgery. Cochrane Library, PubMed, Web of Science, and Embase were searched with the exclusion of non-English articles from inception to 28 February 2022. The motor-sparing and analgesic aspects in true ACB were evaluated using meta-analyses with subsequent subgroup analyses according to the corrected classification system. The meta-analysis includes 19 randomized controlled trials. Compared with the femoral nerve block group, the quadriceps muscle strength (standardized mean difference (SMD) = 0.33, 95%-CI [0.01; 0.65]) and mobilization ability (SMD = -22.44, 95%-CI [-35.37; -9.51]) are more preserved in the mixed ACB group at 24 h after knee surgery. Compared with the true ACB group, the FTB group (SMD = 5.59, 95%-CI [3.44; 8.46]) has a significantly decreased mobilization ability at 24 h after knee surgery. By using the corrected classification system, we proved the motor-sparing effect of true ACB compared to FTB. According to the updated ultrasound anatomy, we suggested proximal ACB to be the analgesic technique of choice for knee surgery. Although a single-shot ACB is limited in duration, it remains the candidate of the analgesic standard for knee surgery on postoperative day 1 or 2 because it induces analgesia with less motor involvement in the era of multimodal analgesia. Furthermore, data from the corrected classification system may provide the basis for future research.

Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty

BackgroundNear-falls should be detected to prevent falls related to the earlier ambulation after Total knee arthroplasty (TKA). The quadriceps weakness with femoral nerve block (FNB) has led to a focus on adductor canal block (ACB). We purposed to examine the risk of falls and the earlier ambulation in each continuous infusion nerve block.MethodsContinuous infusion nerve block (FNB or ACB) was performed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who could ambulate on POD 1, was investigated.ResultsA total of 73 TKA cases, 36 FNB and 37 ACB, met the inclusion criteria. No falls were noted. But episodes of near-falls with knee-buckling were witnessed in 14 (39%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients could ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) and rescue analgesia through POD 3.ConclusionACB was associated with significantly less knee-buckling and earlier ambulation post-TKA, with better quadriceps strength. Our study indicated the incidence of falls and near-falls with continuous infusion nerve blocks, and support the use of ACB to reduce the risk of falls after TKA. It is suggested that a certain number of the patients even with continuous ACB infusion should be considered with the effect of motor branch to prevent falls.

“COMPARISON OF ANALGESIC EFFECT OF INTRAVENOUS FENTANYL VS FEMORAL NERVE BLOCK DURING SPINAL ANESTHESIA POSITIONING IN PATIENTS UNDERGOING FEMUR FRACTURE SURGERY.”

Introduction: For operative procedures of femur fracture, spinal anaesthesia is widely used over general anaesthesia with advantages of better post-operative pain relief, early mobilization, less respiratory complications and avoiding multiple drugs usage. For effectively giving spinal anaesthesia, pain free positioning is must. While giving spinal anesthesia in femur fracture procedures, proper positioning of patient is very difcult because of pain, more so when fracture is displaced. Thus pre operatively intravenous fentanyl, femoral nerve block or fascia iliaca block are some of the procedures which can be used to decrease pain and to provide correct positioning during spinal anaesthesia. To compare theObjectives: analgesic effect and hemodynamic stability of femoral nerve block and intravenous fentanyl. Study was carry out on 70 patients dividedMethods: randomly into two groups of 35 patients each. Group A patients received Femoral nerve block and Group B patients received intravenous fentanyl. Result: VAS score at rest and at movement at 15 minutes in femoral nerve block group was 2.37 +/- 1.45 and 3.37+/- 1.55 in intravenous fentanyl group was 4.94+/- 0.98 and 5.55+/- 0.88.Patient satisfaction score was higher in femoral nerve block group. Analgesic effect ofConclusion: femoral nerve block was better compare to intravenous fentanyl.

A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture

Background &amp; objective: Spinal anesthesia (SA) is preferred for fractured femur surgery but it requires proper positioning which is often very difficult to achieve due to pain. Different methods have been used to control the pain during patient positioning, but the results are inconsistent about the superiority of one over the other. We compared femoral nerve block (FNB) and intravenous ketamine for pain control during positioning for SA in elderly patients with femur fracture.&#x0D; Methodology: A total of 66 patients above 60 y of age were randomly divided into two equal groups; FNB group to receive ultrasound guided FNB with 15-20 ml of bupivacaine 0.25% and ketamine group to receive IV ketamine 0.25 mg/kg. Assessment of VAS scores during positioning before SA was done. Rescue analgesia for pain during positioning was achieved by inj fentanyl IV, and after the surgery by inj morphine IV. Postoperative VAS scores, calculation of total morphine consumption during the first 24 h and any complications were recorded.&#x0D; Results: The VAS score during positioning was lower in FNB group compared to ketamine group (P &lt; 0.001). This was evident by lower recorded doses of pre-spinal rescue fentanyl. FNB group showed better postoperative analgesia, less morphine consumption and less complications.&#x0D; Conclusion: FNB provided better analgesia during positioning for spinal blockade in fractured femur patients. Furthermore, FNB was associated with less adverse effects, better postoperative analgesia and less opioid consumption.&#x0D; Trial Registry: PACTR202112605652525.&#x0D; Abbreviations: SA - Spinal anesthesia; FNB - Femoral nerve block; NSAIDS - Nonsteroidal anti-inflammatory drugs; VAS - Visual Analog Scale&#x0D; Key words: Pain; Spinal anesthesia; Femoral nerve block; Ketamine; Femur surgery&#x0D; Citation: Moussa MEM, Awad HGS, Hamid HSA, Abdellatif AE, Sharaf AGS. A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture. Anaesth. pain intensive care 2022;26(3):297-303.&#x0D; DOI: 10.35975/apic.v26i3.1895&#x0D; Received: January 25, 2022, Reviewed: March 16, 2022, Accepted: March 23, 2022&#x0D;