Suprainguinal Fascia Iliaca Compartment Research Articles

Efficacy of supra-inguinal fascia iliaca compartment block in proximal femoral nail antirotation internal fixation for patients with intertrochanteric fractures.

To evaluate the efficacy of supra-inguinal fascia iliaca compartment block (S-FICB) in patients undergoing proximal femoral nail antirotation (PFNA) internal fixation surgery for intertrochanteric fracture (ITF). Retrospective analysis of 95 patients with ITF undergoing PFNA internal fixation surgery in the First People's Hospital of Yong Kang from March 2021 to August 2023 was performed. Among them, 49 patients received general anesthesia (GA; GA group) and 46 patients received S-FICB combined with general anesthesia (S-FICB group). Mean arterial pressure (MAP), heart rate (HR), anesthesia effect, pain, stress index levels, functional recovery, and adverse reactions were compared between two groups. Perioperative MAP and HR, extubation time, anesthesia recovery time, and dosage of remifentanil and propofol were significantly lower compared to the GA group (P<0.05). Perioperative pain level in the S-FICB group was significantly lower than in the GA group (P<0.05). On the first day after the surgery, stress response of the S-FICB group was significantly lower than that of the GA group (P<0.05). Patients who underwent S-FICB required significantly shorter time for getting out of bed and for straight leg elevation, and lower hospitalization time (P<0.05). Compared to GA, S-FICB for ITF internal fixation surgery is associated with more stable hemodynamics, lower pain levels, less consumption of opioids, lower perioperative stress response, reduced postoperative complications, and shorter hospital stay in patients during the perioperative period.

Local Anesthetic Infiltration, Awake Veno-Venous Extracorporeal Membrane Oxygenation, and Airway Management for Resection of a Giant Mediastinal Cyst: A Narrative Review and Case Report.

Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This is supplemented by a case report illustrating our individual approach for a patient presenting with a subtotal tracheal stenosis due to a large cyst of the thyroid gland. Results: We identified numerous risk stratification grading systems and only a few case reports of regional anesthesia techniques for extracorporeal membrane oxygenation patients. Clinical Case: After consultation with his general physician because of exertional dyspnea and stridor, a 78-year-old patient with no history of heart failure was advised to present to a cardiology department under the suspicion of decompensated heart failure. Computed tomography imaging showed a large mediastinal mass that most likely originated from the left thyroid lobe, with subtotal obstruction of the trachea. Prior medical history included the implantation of a dual-chamber pacemaker because of a complete heart block in 2022, non-insulin-dependent diabetes mellitus type II, preterminal chronic renal failure with normal diuresis, arterial hypertension, and low-grade aortic insufficiency. After referral to our hospital, an interdisciplinary consultation including experienced cardiac anesthesiologists, thoracic surgeons, general surgeons, and cardiac surgeons decided on completing the resection via median sternotomy after awake cannulation for veno-venous extracorporeal membrane oxygenation via the right internal jugular and the femoral vein under regional anesthesia. An intermediate cervical plexus block and a suprainguinal fascia iliaca compartment block were performed, followed by anesthesia induction with bronchoscopy-guided placement of the endotracheal tube over the stenosed part of the trachea. The resection was performed with minimal blood loss. After the resection, an exit blockade of the dual chamber pacemaker prompted emergency surgical revision. The veno-venous extracorporeal membrane oxygenation was explanted after the operation in the operating room. The postoperative course was uneventful, and the patient was released home in stable condition. Conclusions: Awake veno-venous extracorporeal membrane oxygenation placed under local anesthetic infiltration with regional anesthesia techniques is a feasible individualized approach for patients with high risk of airway collapse, especially if the mediastinal mass critically alters tracheal anatomy. Compressible cysts may represent a subgroup with easy passage of an endotracheal tube. Interdisciplinary collaboration during the planning stage is essential for maximum patient safety. Prospective data regarding risk stratification for veno-venous extracorporeal membrane oxygenation cannulation and effectiveness of regional anesthesia is needed.

Ultrasound-guided anterior iliopsoas muscle space block compared with fascia iliaca compartment block in elderly hip surgery: A randomized controlled trial.

Elderly hip fracture patients experience severe pain. Surgical stress and pain during position changes for spinal anesthesia puncture can adversely affect hemodynamics. The objective of this study was to compare the perioperative analgesic efficacy of anterior iliopsoas muscle space block with supra-inguinal fascia iliaca compartment block (S-FICB) in elderly patients undergoing hip surgery. In this randomized control trial, 66 patients were randomly assigned to either the iliopsoas space or the S-FICB group. Each patient received 30 mL of ropivacaine 0.375%. Perioperative pain scores were assessed and compared in both groups. The primary outcome was pain scores during changes in position for neuraxial anesthesia. Secondary outcomes included postoperative pain intensity, inflammatory markers for 12 to 24 hours, and perioperative adverse reactions. The iliopsoas space group demonstrated a faster median block onset of 7 [6-8] minutes compared to S-FICB 14.50 [13-16] minutes (P < .001). Neuraxial anesthesia position changes resulted in lower pain scores for iliopsoas 2 [1-2] versus S-FICB 3 [3-4] (P < .001). Resting pain scores were similar at 12 hours post-surgery, but during exercise, the iliopsoas group had significantly lower scores [1-2] compared to S-FICB 4 [2-4] (P < .001). After 24 hours, C-RP levels were lower in the iliopsoas group (14.86 ± 1.23 mg/L) than S-FICB (17.90 ± 1.25 mg/L) (P < .001). The 2 groups differed from one another (P < .001). These findings suggest that iliopsoas space block may offer faster, superior dynamic pain control, and potentially reduced inflammation compared to FICB block for postoperative pain management. In elderly hip fracture patients, the anterior iliopsoas space block works slightly better than S-FICB at providing effective perioperative analgesia.

Comparison of ultrasound-guided fascia iliaca compartment block versus the combined obturator nerve and adductor canal block application in postoperative analgesia for patients undergoing arthroscopic knee surgery

Background: Arthroscopic knee surgery is a surgical intervention that is frequently performed by orthopedic clinics and new studies are constantly carried out by anesthetists to ensure effective pain control. This study aimed to compare the efficacy of ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) versus the combined adductor canal and obturator nerve block application in terms of postoperative analgesia in patients undergoing arthroscopic knee surgery under spinal anesthesia.Materials and Method: Sixty patients, who underwent arthroscopic knee surgery under elective conditions were included in the study. They were randomly divided into two groups, Group 1 (n=30) and Group 2 (n=30), using a lottery method. Patients operated under spinal anesthesia received ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) for Group 1. The combined adductor canal and obturator nerve block for Group 2 at the end of the surgery. Intravenous patient-controlled analgesia (PCA) device containing tramadol was connected to all patients in both groups, and they were evaluated for Visual Analog Scale (VAS) scores at 0, 2, 4, 12, and 24 hours of ward follow-up. The amount of PCA used at 24 hours, additional analgesic use, development of side effects, mobilization capabilities, and satisfaction levels were assessed at the end of 24 hours.Results: There were no significant differences between the groups in terms of demographic characteristics and the type of surgery performed (p&gt;0.05). In Group 1, where fascia iliaca block was applied the block administration time was observed to be significantly shorter compared to Group 2 (p&lt;0.05). No significant differences were observed between the two groups in terms of postoperative VAS scores, PCA usage amounts, incidence of side effects, postoperative mobilization abilities, and satisfaction measures (p&gt;0.05).Conclusions: Ultrasound-guided fascia iliaca compartment block alone can be effectively applied for postoperative analgesia in patients undergoing arthroscopic knee surgery, instead of combined adductor canal and obturator nerve block.

Ultrasound-Guided Suprainguinal Fascia Iliaca Compartment Block in Patients Undergoing Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The use of fascia iliaca compartment block (FICB) has been widely encouraged for hip surgery; however, meta-analyses showed mixed results in terms of its efficacy in reduction in analgesic consumption and pain score. These meta-analyses included all forms of FICB approaches, which may diminish the effect size of the therapy. Suprainguinal FICB (s-FICB) has been shown to be superior to other FICB approaches including the ultrasound-guided infrainguinal approach and the landmark approach. This systematic review and meta-analysis aim to compare opioid consumption, pain score, and complications after s-FICB to control for patients undergoing hip surgery. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42023460377). We performed a systematic literature search in Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases from inception to 16August 2023 to identify randomized controlled trials (RCTs) that evaluated the efficacy of s-FICB versus control for patients undergoing hip surgery. Data were independently extracted by two reviewers, and disagreements were resolved by consensus or by discussion with a third investigator. The primary outcome is the 24-houroral morphine equivalent daily dose (oMMED). The secondary outcome includes oMMED at different timepoints, and pain score. The Cochrane risk of biastool (Cochrane, London, England) was used to assess the risk of bias. The certainty of evidence was assessed via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data were synthesized using a random-effects model. Trial sequence analysis is performed on opioid consumption 24 hours post operation. Eleven randomized controlled trials were included. Arthroscopic hip surgery was performed in three studies involving 222 patients, hip and femur fracture surgeries were performed in three studies involving 149 patients, and total hip arthroplasty was performed in five studies involving 483 patients. In studies involving arthroscopic hip surgery, s-FICB did not improve intra-operative and post-operative opioid consumption and post-operative pain score. In studies involving hip and femur fracture surgeries, s-FICB was associated with a non-significant difference in opioid consumption at 24 hours after surgery and post-operative pain score at 12 hours and 24 hours after surgery. However, the result of the trial sequential analysis (TSA) was not definitive, indicating that additional research is necessary to draw conclusive outcomes. In studies involving total hip arthroplasty, s-FICB was associated with a significant reduction in post-operative opioid consumption at 24 and 48 hours with conclusive results in trial sequential analysis. In conclusion, s-FICB is superior to placebo for patients undergoing total hip arthroplasty. For patients undergoing arthroscopic hip surgery, s-FICB is unlikely to be beneficial. With regardto hip fracture surgery, additional research is necessary to draw conclusive outcomes.

A Comparative Study Between Femoral Nerve Block and Suprainguinal Fascia Iliaca Compartment Block for Post-Operative Analgesia in Femur Fracture Fixation

Introduction: Femur fractures and their surgical fixations are common. Adequate postoperative pain relief is mandatory as it facilitates rapid recovery by enhancing early ambulation and mitigating stress response. This is barely achievable with conventional pain control methods. Ultrasound-guided regional blocks like femoral nerve block and supra-inguinal fascia iliaca compartment block are simple yet promising techniques for postoperative analgesia in femur fractures. Aims: To compare post-operative analgesia duration and satisfaction attained between the patients receiving ultrasound-guided femoral nerve block with, those receiving ultrasound-guided supra-inguinal fascia iliaca compartment block, after femur fracture fixation. Methods: Seventy-four patients, aged 16−85 years, of either sex, ASA I−II, who underwent femur fracture surgical fixations under spinal anesthesia, were randomly divided into two equal groups: groups 1 and group 2. Postoperatively, Group 1 (n= 37) received a femoral nerve block with 15 ml 2.5% bupivacaine whereas Group 2 (n = 37) received a supra-inguinal fascia iliaca compartment block with 30 ml 2.5% bupivacaine. Duration of analgesia, patients' level of satisfaction, visual analogue scale scores, and hemodynamic parameters at different time intervals were recorded in the first 24 hours postoperatively and compared. Results: The demographic profiles between the two groups were comparable. Group 2 had a significantly longer duration of analgesia than Group 1, with the means 795.14 vs 538.65 minutes respectively, and a P value of .002. Although group 1 patients had predominantly 3 and 4 levels of satisfaction whereas group 2 had 4 and 5, there was no statistically significant difference in patients’ level of satisfaction between the groups (P=.249). Conclusion: Supra-inguinal fascia iliaca block provides a longer duration of analgesia than femoral nerve block in femur fracture fixation. The level of satisfaction in both groups is high and comparable.

A comparative study between postoperative analgesia of suprainguinal fascia iliaca compartment block (SIFI) and lumbar erector spinae plane block (ESPB) in hip arthroplasty

ABSTRACT Background Suprainguinal fascia iliaca (SIFI) block offers efficient pain relief in total hip arthroplasty, although motor blockage is a common complication. Erector spinae plane block (ESPB) is a promising technique with less motor block; in research, we evaluate the efficacy of both blocks regarding analgesia and early mobilization. Patients and method Fifty-six patients who underwent total hip replacement following spinal anesthesia were divided to either treated with ultrasound guided suprainguinal fascia iliaca (SIFI) block or ultrasound guided ESPB at the end of surgery. The primary measure of interest was the pethidine consumed within a 24-hour period following the surgical procedure. Subordinate outcomes were: first rescue pethidine time, pain scores, and onset of ambulation. Post-operative vomiting, nausea, and other adverse events were recorded. Results Fifty-six patients were involved in the study. No significant statistical variances were found in pethidine consumed at 24 hours (p = 0.122) or pain scores and rescue analgesia timing (p = 0.075). ESPB provided an early onset of ambulation with a highly significant divergence (p < 0.001). Conclusion We concluded that ESPB has a similar analgesic, opioid sparing effect to SIFI block after total hip arthroplasty (THA) and provides early onset of ambulation.

Ultrasound-guided suprainguinal fascia iliaca compartment block and early postoperative analgesia after total hip arthroplasty: a randomised controlled trial

BackgroundHip replacement surgery can be painful; postoperative analgesia is crucial for comfort and to facilitate recovery. Regional anaesthesia can reduce pain and postoperative opioid requirements. The role of ultrasound-guided suprainguinal fascia iliaca block for analgesia after elective total hip arthroplasty is not well defined. This randomised trial evaluated its analgesic efficacy. MethodsConsenting participants (134) scheduled for elective primary total hip arthroplasty under spinal anaesthesia were randomly allocated to receive ultrasound-guided fascia iliaca block with ropivacaine 0.5% or sham block with saline. The primary outcome was opioid consumption in the first 24 h after surgery. Additional outcomes included pain scores at 4, 8, 12, and 16 h, opioid-related side-effects (nausea, vomiting, pruritis), ability to perform physiotherapy on the first postoperative day, and physiotherapist-assessed quadriceps weakness. ResultsThere were no significant differences in 24-h opioid consumption (block vs sham block, mean difference −3.2 mg oral morphine equivalent, 95% confidence interval −15.3 to 8.1 mg oral morphine equivalent, P=0.55) or any other prespecified outcomes. ConclusionsIn patients undergoing primary total hip arthroplasty, ultrasound-guided suprainguinal fascia iliaca block with ropivacaine did not confer a significant opioid-sparing effect compared with sham block. There were no differences in other secondary outcomes including pain scores, opioid-related side-effects, or ability to perform physiotherapy on the first postoperative day. Clinical trial registrationwww.clinicaltrials.gov (NCT03069183).

Comparison between peri‑capsular nerve group and supra inguinal fascia iliaca block for analgesia and ease of positioning during neuraxial anesthesia in hip fracture patients: A randomized double-blind trial

ABSTRACT Introduction Patients with fractured hips almost always have marked pain that results in unfavorable positioning for the central neuraxial block. It was revealed that regional block approaches, including suprainguinal fascia-iliaca compartment block (S-FICB) and pericapsular nerve group (PENG) block, might effectively alleviate pain in patients with hip fractures. This research aimed to evaluate the influence of S-FICB and PENG block on patients positioning during central neuraxial block and compare their analgesic efficacy. Methods This randomized double-blinded trial included 60 cases aged ≥ 40 years old and ASA I-III with hip fracture with persistent pain and scheduled for surgery under spinal anesthesia (SA). Cases were randomized equally into two groups. Group I (S-FICB) received ultrasound (US) guided S-FICB, and group II (PENG group) received US guided PENG. Both blocks were performed by the same operator using 23 ml of ropivacaine 0.25% + 2 ml (8 mg) of dexamethasone. Results The ease of spinal positioning (EOSP) score was significantly better in the PENG group than the S-FICB group (p < 0.001). Twenty minutes after blocks, the numeric rating scale (NRS) reduced significantly in PENG than in SFICB groups at rest (p < 0.015) and movement (p < 0.010). The first request for analgesia, NRS in the first 24-hour period postoperatively, and the number of tramadol doses were similar between both groups (p = 0.552) and (p < 0.370), respectively. Conclusions Although each block provides comparable duration of postoperative analgesia, PENG block achieved more analgesic effect and easier positioning than S-FICB for SA in patients who had hip fractures surgery.

The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study.

In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively. According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

Analgesic Efficacy of Suprainguinal Fascia Iliaca Compartment Block (SFICB) vs Combined Pericapsular Nerve Group (PENG) Block with Lateral Femoral Cutaneous Nerve Block (LFCN) in Hip Surgery

Background: Pain management for hip fracture is challenging due to complex anatomical variations and patient positioning during surgery. Though various modalities of regional techniques are being used for pain management, none of them has proven superiority. Recently fascia iliaca compartment block and pericapsular nerve group block have drawn lots of attention due to simplicity and superior pain control. In this study suprainguinal fascia iliaca compartment block (SFICB) was compared with pericapsular nerve group (PENG) block in combination with lateral femoral cutaneous nerve (LFCN) block to evaluate the analgesic efficacy and utility in fracture neck femur patients.Methods: This prospective study was conducted from January 2022 to December 2022. Total 40 patients were allocated in two groups, suprainguinal fascia iliaca compartment block (Gr-F) or PENG with LFCN block (Gr-P) group. 30 minutes after performing the block, pain was assessed with NPRS scale during positioning for combined epidural anaesthesia. Then pain assessment was done 2 hour for first 12 hours followed by 4 hour in following 12 hours. Haemodynamic profile, duration of analgesia and requirement of rescue analgesics were recorded.Results: During positioning of the patient for central neuraxial block, NPRS was (2.5 ± 0.3) for Gr-P and (4.5 ± 0.6) for Gr-F with p = 0.039. For Gr-F, 20% patient required Dexmedetomidine infusion during positioning. The onset of analgesia in Gr-P was (10.56 ± 3.46) minutes and in Gr-F was (15.86 ± 3.3) minutes with p &lt; 0.05. Duration of analgesia during active movement was 14.6 (±1.09) hours for Gr-P and 10.2 (±2.06) hours for Gr-F with p value &lt; 0.05.Conclusion: Combination of PENG with LFCN block provides a superior analgesia characterised by early onset action, less pain score at rest and on movement during positioning of the patient and prolong duration of action on active movement postoperatively.

Comparison of ultrasound-guided suprainguinal fascia iliaca compartment block and pericapsular nerve group block for postoperative analgesia and associated cognitive dysfunction following hip and proximal femur surgery.

Hip and proximal femur fractures in any age group require surgical reduction and fixation. Various regional techniques are popular for lower limb surgeries but adequate analgesia from these blocks is variable depending upon the type of surgery. We conducted a study to compare ultrasound-guided suprainguinal fascia iliaca compartment (SFIC) block and pericapsular nerve group (PENG) block for postoperative analgesia and cognitive dysfunction in patients undergoing hip and proximal femur surgery. Sixty-six patients, aged 18-65 years, American Society of Anaesthesiologists I and II undergoing hip and proximal femur surgery were randomized into two groups, group F for SFIC block (n = 33) and group P for PENG block (n = 33). After completion of surgery, an ultrasound-guided SFIC or PENG block was given. Visual analogue scale (VAS) score on movement and rest, muscle power (quadriceps strength), time to first rescue analgesia, total analgesic requirement, and postoperative cognitive dysfunction in the first 24 h were observed. A total of 66 patients participated in the study and 30 in each group were analyzed. VAS score at movement was significantly lower (P = 0.018) with better quadriceps muscle strength (P = 0.001) in the PENG block compared to the SFIC block group at 24 h postoperatively. Total opioid consumption in morphine equivalents (P = 0.03) was lower in the PENG block than in the SFIC block group for 24 h (28.5% vs. 71.4%). Cognitive impairment was comparable in both groups (3.3% vs. 16.7%, P = 0.097). PENG block is better than SFIC block for postoperative analgesia with lesser opioid consumption, whereas postoperative cognitive dysfunction was comparable in both groups.

Efficacy of Different Volumes of 0.2% Ropivacaine in Suprainguinal Fascia Iliaca Compartment Block for Multimodal Analgesia in Lower Limb Surgery

Efficacy of Different Volumes of 0.2% Ropivacaine in Suprainguinal Fascia Iliaca Compartment Block for Multimodal Analgesia in Lower Limb Surgery

Comparison between pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve block and supra-inguinal fascia iliaca compartment block (S-FICB) for total hip arthroplasty: a randomized controlled trial

PurposeTo assess the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block in controlling postoperative pain and promoting recovery of lower extremity after total hip arthroplasty (THA), and to compare its effectiveness with supra-inguinal fascia iliaca compartment block (S-FICB).Materials and methods92 patients undergoing THA with general anesthesia were randomly allocated to receive either a PENG with LFCN block (n = 46) using 30 ml 0.33% ropivacaine (20 ml for PENG block, 10 ml for LFCN block), or an S-FICB (n = 46) using 30 ml 0.33% ropivacaine. The primary outcome was the time to first postoperative walk. The secondary outcomes included intraoperative remifentanil consumption, postoperative hip flexion degree and muscle strength of the operative lower limbs in the supine position, pain scores (static and dynamic), rescue analgesia, postoperative nausea and vomiting (PONV), and nerve block-related complications.ResultsThe combination of PENG with LFCN blocks resulted in an earlier first postoperative walking time (19.6 ± 9.6 h vs 26.5 ± 8.2 h, P < 0.01), greater postoperative hip flexion degree at 6 h, 24 h and 48 h (all P < 0.01), and higher muscle strength of the operative lower limbs at 6 h after surgery (P = 0.03) compared to S-FICB. The difference in pain scores (static and dynamic) was only statistically significant at 48 h (P < 0.05). There were no differences in the other outcomes.ConclusionsPENG with LFCN blocks is more effective than S-FICB in shortening the time to first postoperative walk and preservation hip motion after THA, which makes it a suitable addition to enhanced recovery programs following surgery.

95% effective volume of ropivacaine for ultrasound‑guided supra‑inguinal fascia iliaca compartment block

BackgroundHip arthroplasty is effective in treating hip diseases, such as osteoarthritis and hip fracture, but it often brings severe trauma and pain. In recent years, ultrasound-guided supra-inguinal fascia iliaca compartment block(S-FICB) has become a widely used nerve block method for analgesia in hip arthroplasty.MethodsFifty-three patients preparing for hip arthroplasty were prospectively enrolled. S-FICB was performed under ultrasound guidance, and inject 0.33% ropivacaine into the space. Using the biased-coin design (BCD) sequential allocation method. The initial volume of 0.33% ropivacaine was 30ml. In case of failure, the next patient received a higher volume (defined as the previous volume with an increment of 1.2 mL). If the previous patient had a successful block, the next patient was randomized to a lower volume (defined as the previous volume with a decrement of 1.2 mL), with a probability of b = 0.05, or the same volume, with a probability of 1 − b = 0.95. The study was stopped when 45 successful blocks were achieved.ResultsForty-five patients (84.9%) were blocked successfully. The 95% effective volume (EV95) was 34.06ml (95%CI 33.35 ~ 36.28ml). There were 31 patients with non-fracture in this study. The quadriceps muscle strength decreased in only two patients. Moreover, they both received 34.8ml of ropivacaine for S-FICB. Twenty-two patients had hip fractures. There were 3 patients (14%) with failed blocks and 19 patients (86%) with successful blocks. However, all fracture patients experienced less pain after S-FICB.ConclusionEV95 of 0.33% ropivacaine for ultrasound-guided S-FICB was 34.06ml.Trial registrationThe trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100052214, registration date: 2021 October 22).

Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series.

The complex innervation of the hip joint may require a combined peripheral nerve block technique for perioperative effective analgesia and early recovery. The pericapsular nerve group (PENG) and suprainguinal fascia iliaca compartment blocks (SIFICB) are interfascial plane blocks aiming to involve the femoral, obturator, accessory obturator, and lateral femoral cutaneous nerves. The data still lacks in providing the standard of care for patients undergoing hip surgery. In this case series, we studied the efficacy of ultrasound-guided combined PENG block and SIFICB for perioperative analgesia and functional recovery in patients posted for hip surgery. We studied 10 adults of either gender who underwent close reduction and internal fixation of hip fracture. Before receiving spinal anesthesia, all patients had PENG block and SIFICB with 10 ml and 20 ml of local anesthetics respectively. Patients were observed for ease of giving sitting position for spinal anesthesia (EOSP), visual analogue score (VAS) at rest and 15° leg elevation, duration of postoperative analgesia, the cumulative requirement of rescue analgesic at 48 hours and ability of patients to undergo weight-bearing trial postoperatively. The static and dynamic VAS before receiving spinal anesthesia and postoperatively, was reduced compared to pre-block. The optimal position for delivering spinal anesthesia was possible to achieve as the patients were able to sit comfortably after 10 minutes of receiving both blocks. Duration of postoperative analgesia also extended up to 18 hours with the cumulative requirement of injection tramadol restricted to two doses postoperatively. All were able to walk down a minimum of 55 steps after 48 hours of completion of surgery. Combining PENG block along with SIFICB is effective in the provision of perioperative analgesia with a considerable reduction in opioids and enhanced functional recovery due to motor sparing effect after surgical repair of the hip fracture.

Spread of Local Anesthetic in the Fascia Iliaca Compartment Confirmed on Inguinal Echocardiography after Suprainguinal Fascia Iliaca Compartment Block：A Case Report

Spread of Local Anesthetic in the Fascia Iliaca Compartment Confirmed on Inguinal Echocardiography after Suprainguinal Fascia Iliaca Compartment Block：A Case Report

Ultrasound-Guided Peripheral Nerve Blocks for Hip Surgery: A Concise Perspective.

Ultrasound implementation for the facilitation of peripheral nerve blocks is well established. Ultrasound-guided lumbar plexus, femoral, fascia iliaca and supra-inguinal fascia iliaca compartment, pericapsular nerve group and quadratus lumborum nerve blocks have been employed for analgesia purposes in hip surgery. The combination of motor-sparing regional anesthesia strategies for optimal postoperative pain control with recovery protocols targeting to early and safe patients' mobilization constitute the current dogma of orthopedic surgery. Therefore, this editorial sets out to revisit the role of peripheral nerve blocks in postoperative pain management of hip surgery patients, under the prism of current orthopedic practice.

The effect of suprainguinal fascia iliaca blocks on morphine use after total hip arthroplasty: a retrospective cohort study

Background: Good pain control after total hip arthroplasty improves patient outcomes. Fascia iliaca blocks are used as part of multimodal pain management. Objectives: We compared patient-controlled intravenous (PCIA) morphine use between patients with pre- operatively placed suprainguinal fascia iliaca compartment block (SFICB), using 40 ml ropivacaine 0.375%, and a control group (NB). Design and setting: Retrospective, single-centre cohort study. Methods: A database of the Imeldaziekenhuis in Bonheiden, Belgium was analysed. This database contained data of total hip arthroplasties performed between April 29 2019 and May 7 2021. Inclusion criteria were age &gt;18 years and undergoing an elective total hip arthroplasty. The exclusion criterium was incomplete data registration. 277 patients were included in the study, 203 patients in the SFICB group and 74 in the NB group. A retrospective comparison between these two groups was performed. Main outcome measures: The primary endpoint was PCIA morphine use at 24 hours. Secondary endpoints were PCIA morphine use between 24 and 48 hours, Numeric Rating Scale pain scores, peroperative sufentanil use, postoperative piritramide consumption and nausea. Results: The median dose of PCIA morphine at 24 hours was 5 [2 to 9] mg in the SFICB group compared to 9.5 [5 to 15.75] mg in the NB group (P=0.000034). Lower pain scores at 48 hours (P=0.0003) and peroperative sufentanil consumption (P=0.015) were reported in the SFICB group. The median NRS pain score (P=0.02) and intravenous piritramide consumption (P=0.014) on the recovery ward were significantly higher in the SFICB group than in the NB group. No difference was reported for PCIA morphine use between 24 and 48 hours, pain score at 24 hours and nausea. Conclusions: Preoperative suprainguinal fascia iliaca block leads to less PCIA morphine consumption the first 24 hours, lower NRS pain scores at 48 hours and lower peroperative opioid need for total hip arthroplasty.

Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial

IntroductionPosterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique.MethodsData from 86 patients...