Ultrasound-guided Fascia Iliaca Compartment Block Research Articles

Evaluation of local anaesthetic with adjuvants for postoperative analgesia through ultrasound-guided Fascia Iliaca compartment block in hip procedures

Evaluation of local anaesthetic with adjuvants for postoperative analgesia through ultrasound-guided Fascia Iliaca compartment block in hip procedures

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>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<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>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.

Comparison of the efficacy and safety of different puncture routes for ultrasound-guided fascia iliaca compartment block for early analgesia after hip arthroplasty: A meta-analysis.

This study aimed to compare the effect of ultrasound-guided fascia iliaca compartment block with different puncture sites on postoperative analgesia in patients undergoing hip arthroplasty. We searched the PubMed, Web of Science, EBSCO, Wiley Library, Embase, China National Knowledge Infrastructure, and Wanfang databases for literature on ultrasound-guided fascia iliaca compartment block through different puncture sites in hip replacement patients. The software package R (4.2.1) was used in the meta-analysis. The meta results showed the suprainguinal approach (SA) puncture pathway had a significantly longer operative time than the infrainguinal approach (IA) pathway (mean deviation [MD] = 0.97, 95% confidence interval [CI] [0.09, 1.84], P < .01) when performing orthopedic surgery. In terms of nerve block efficacy, only the block rates of the obturator nerve, lateral femoral cutaneous nerve, and femoral nerve groups did not show significant differences between the SA and IA pathways. In contrast, the results of the Meta combined effect size of visual analogue scale scores during postoperative activity showed that the SA puncture pathway significantly reduced patients' pain scores compared with the IA pathway at the T1 (3-6 h) and T2 (8 h) time points (MD = -0.39, 95% CI [-0.77, -0.01], P = .04 in the T1 group; MD = -0.58, 95% CI [-0.95, -0.21], P < .01). The differences in pain scores at the T3 (12 h) and T4 (24 h) time points were not significant, and in terms of adverse reaction rates, the differences in the incidence of pruritus, sedation, urinary retention, and nausea and vomiting were not significant. This study demonstrates that the SA puncture pathway has a significant advantage over the IA pathway in reducing active pain in early postoperative pain management without increasing the risk of adverse events. This finding supports the prioritization of SA pathway in clinical practice where postoperative pain control is considered. Future research should continue to explore the use of SA pathway in different patient populations and types of surgery, as well as their impact on long-term postoperative recovery, with the aim of optimizing individualized postoperative pain management strategies.

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

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

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

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

A Randomized Comparative Study of Ultrasound-guided Femoral Nerve Block Versus Fascia Iliaca Compartment Block for Reducing Pain Associated with Positioning for Spinal Anesthesia in Patients with Proximal Femur Fracture

Abstract Context: Peripheral nerve blocks are widely accepted as the gold standard for providing perioperative and postoperative analgesia in lower limb surgeries. Aims: This study aimed to determine which block is better in terms of onset of action among ultrasound-guided femoral nerve block (USG FNB) and ultrasound-guided fascia iliaca compartment block (USG FICB) for positioning for spinal anesthesia in patients operated for proximal femur fracture and find the total duration of analgesia, total consumption of rescue analgesics, and complications. Settings and Design: This was a prospective, randomized, comparative, interventional, single-blinded study. Subjects and Methods: Patients in Group A (n = 43) were administered USG FNB with 15 mL of 0.25% bupivacaine and patients in Group B (n = 43) were administered USG FICB with 30 mL of 0.25% bupivacaine. The primary objective was to find out which nerve block was better in reducing pain associated with a sitting position for spinal anesthesia, and the secondary objective was to find the difference in the mean time of first rescue analgesia. Statistical Analysis: Data analysis was done using the Student’s t-test and Chi-square tests. Results: Before block administration, patients in Group A had a Visual Analog Scale (VAS) score of 7.65 ± 0.75, and patients in Group B had a VAS score of 7.79 ± 0.74 (P = 0.389). The primary objective was to achieve VAS &lt; 3. It was 3 min in Group A and 5 min in Group B (P = 001). The secondary objectives were the duration of postoperative analgesia in Group A was 330.58 ± 28.16 min and in Group B was 482.33 ± 19.89 min (P &lt; 0.001). The mean value of tramadol consumption in 24 h in both the study groups was comparable (P = 1.000). The anesthesiologist satisfaction score, patient satisfaction score, and proportion of side effects in both study groups were comparable. Conclusion: USG FICB is more efficacious. Although the onset of action delays by 2 min, it provides longer postoperative analgesia compared to USG FNB.

Fascia iliaca compartment block mitigates the fluctuations in heart rate variability and reduces pain with opioid consumption in elderly individuals with hip fractures: A randomized controlled trial

BackgroundHip fractures, commonly known as the “terminal fracture of life,” frequently necessitate prompt surgical intervention and are accompanied by significant perioperative pain. ObjectiveThis investigation was performed to assess the impact of fascia iliaca compartment block (FICB) on heart rate variability during the perioperative period in elderly individuals with hip fractures. DesignSingle-center, randomized, controlled clinical trial. SettingThe study was conducted from September 2021 to February 2023 at one tertiary care hospital in China. ParticipantsPatients aged ≥60 years who underwent general anesthesia for hip fracture surgery were screened for enrollment. Eighty patients were initially assessed for eligibility, 70 underwent randomization, and 62 were included in the final analysis. MethodsPreoperatively, the patients were randomly allocated to either receive (Group F) or not receive (Group C) ultrasound-guided suprainguinal FICB. The primary endpoint was heart rate variability indicators at the corresponding time points. The secondary endpoints included the mean arterial pressure and heart rate measured at different time points [upon admission to the operating room (T1), during positioning (T2), at the time of skin incision (T3), 30 min after the start of surgery (T4), and 6 h postoperatively (T5)] and visual analogue scale (VAS) score, dose of oral pain medication over 24 h, and satisfaction scores were valued. ResultsCompared with Group C, Group F had a significantly reduced low-frequency band, high-frequency band, and low-/high-frequency band ratio at T3, T4, and T5 (P < 0.05). Group F also had a lower heart rate at T2, T3, T4, and T5 (P < 0.05). Moreover, Group F had lower flurbiprofen dosages at 24 h postoperatively (P < 0.05) and lower resting VAS scores at 6 and 24 h postoperatively (P < 0.05). ConclusionUtilization of ultrasound-guided FICB has the potential to yield efficacious analgesic effects, mitigate the pronounced fluctuations in heart rate induced by surgical stimulation, and maintain autonomic function stability to a certain degree.

A Comparative Study of Postoperative Analgesic Efficacy of Suprainguinal versus Infrainguinal Approach of Ultrasound-guided Fascia Iliaca Compartment Block using 0.2% Ropivacaine in Patients Undergoing Surgery for Hip Fracture under Spinal Anesthesia

Abstract Context: Fascia iliaca compartment block (FICB) is a useful modality to provide postoperative analgesia in patients with hip fracture undergoing surgery. Aims: The aims of this study were to compare the analgesic efficacy of suprainguinal versus infrainguinal approach of ultrasound-guided FICB using 0.2% ropivacaine in patients undergoing surgery for hip fracture under spinal anesthesia. Settings and Design: It was a prospective, randomized, controlled study. Subject and Methods: Group A (n = 25) received ultrasound-guided FICB by suprainguinal approach and Group B (n = 25) received ultrasound-guided FICB by infrainguinal approach. The primary objective was to compare 24-h postoperative analgesic efficacy using Numeric Rating Scale (NRS) score. Statistical Analysis: For data analysis, t-test, Mann–Whitney test, and Chi-square test were applied. Results: NRS score after 30 min of FICB in Group A was 2.36 ± 1.11 which was lower in comparison to 3.28 ± 0.94 in Group B (P = 0.002). NRS score during positioning in Group A was 2.16 ± 0.90, which was lower than Group B 3.08 ± 0.81 (P = 0. 0004). Greater block coverage was achieved in obturator nerve distribution in Group A 0.76 ± 0.52 compared to 0.16 ± 0.37 in Group B (P &lt; 0.001). The total duration of analgesia was 493.40 ± 214.83 min, which was more in Group A than in Group B 367.48 ± 63.92 min (P = 0.007). Quality of recovery (QoR) score out of 150 in Group A was 120.60 ± 8.91 compared to 110.40 ± 7.59 in Group B (P &lt; 0.001). Conclusion: FICB by suprainguinal approach provides better analgesia, sensory block coverage, and conditions for positioning for spinal anesthesia and also has a higher time to first rescue analgesic requirement with better QoR compared to infrainguinal approach.

Effects of ultrasound-guided fascia iliaca compartment block combined with general anesthesia under tracheal intubation on the vital signs and quality of recovery of elderly patients receiving hip replacement

Effects of ultrasound-guided fascia iliaca compartment block combined with general anesthesia under tracheal intubation on the vital signs and quality of recovery of elderly patients receiving hip replacement

Ultrasound-Guided Fascia Iliaca Compartment Block Simulation Training in an Emergency Medicine Residency Program.

Introduction Geriatric hip fractures present a difficult challenge in the emergency department (ED) to achieve adequate analgesia. Opioid-sparing ultrasound-guided fascia iliaca compartment blocks (UFIB) have been shown to be both safe and effective in treating pain from hip fractures.In this study, we investigated the teachability of UFIB to emergency medicine (EM) residents using simulation models and also assessed if UFIB training increases its utility in the ED. Methods We created a UFIB model to simulate the procedure in a controlled environment. Sixteen residents from Loma Linda Emergency Medicine Residency participated in a pre-workshop survey and hands-on UFIB workshop. Comfort level in performing UFIB and confidence levelin needle finding skills during UFIB were analyzed, plotted, and represented graphically. Results Comfort level in performing UFIB increased by approximately 50% (p < 0.01). Success rates also increased by 460% (p<0.05) after the workshop. However, the UFIB continued to be underutilized as 44% of respondents expressed that there is a "lack of time" to perform UFIB during their shifts. Conclusion A single one-hour workshop increased comfort level in performing UFIB and helped residents successfully achieve better pain control in patients with hip fractures.However, residents continued to refrain from using UFIB because it is too time-consuming.

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

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

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Block and Three-in-one Block in Elderly Patients Undergoing Hip Surgeries: A Randomised Double-blinded Clinical Trial

Introduction: Hip surgery is a common surgical procedure in the elderly population, leading to significant pain. Ultrasound (USG) guided regional nerve blocks are a newer, safe, and effective postoperative pain control modality for elderly patients. Aim: To compare the analgesic efficacy of Fascia Iliaca Compartment Block (FICB) with the three-in-one block for postoperative analgesia in elderly patients after lower limb orthopaedic surgeries. Materials and Methods: It was a randomised double- blinded study performed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India on 60 elderly patients of Americian Soceity of Anaesthesiologists (ASA) class I-II scheduled for elective hip and femur shaft surgery under spinal anaesthesia.All patients were randomly allocated into two groups. Group A received ultrasound-guided FICB with 35-40 mL of 0.25% bupivacaine, and group B received ultrasound-guided three-in-one block with 35-40 mL of 0.25% bupivacaine after completion of surgery. In the postoperative period, pain was assessed using the Visual Analogue Scale (VAS), and inj. diclofenac sodium 1.5 mg/kg intravenous (i.v.) was given as rescue analgesic whenever VAS was ≥4. The primary outcome was changes in VAS scores at rest and during passive leg elevation between the two groups at various time intervals within 24 hours. Secondary outcomes measured were the duration of analgesia and total rescue analgesic required in 24 hours. Qualitative variables were compared between groups using the Chi-square test. A p-value&lt;0.05 was considered statistically significant. Results: Demographic data were comparable in both groups, with a mean age of 65.11±1.89 years in Group A and 65.57±1.46 years in Group B. The VAS score at rest was significantly lower in Group A compared to Group B at the 6th hour (1.21±1.17 vs. 1.61±0.78) and 12th hour (2.80±0.12 vs. 3.33±0.92), respectively. The VAS score during passive movement was significantly lower in Group A at the 6th hour and 12th hour compared to Group B. The mean time for the first demand of rescue analgesic was 9.27±2.16 hours in the Fascia Iliaca Compartment Block (FICB) group and 6.67±1.45 hours in the three-in-one group. The difference was significant, with a p-value of 0.006. The mean requirement of total rescue analgesia was 133.33±33.27 mg in Group A and 198.53±29.16 mg in Group B, which was statistically significant. Conclusion: The fascia iliaca block had lower pain scores both at rest and during passive movement compared to the three-inone block. Total analgesic requirement was lower in the fascia iliaca group compared to the three-in-one block group.

Ultrasound-guided continuous fascia iliaca compartment block for perioperative pain management in elderly patients undergoing hip fracture surgery

To study the effect of ultrasound-guided fascia iliaca compartment block on perioperative analgesia and postoperative complications in geriatric patients with hip fractures. A total of 127 elderly patients undergoing hip fracture surgery from January 2021 to September 2021 were randomized to receive ultrasound-guided continuous fascia iliaca compartment block(group F) either intravenous analgesia control group(group C). There were 62 cases in group F, including 19 males and 43 females with an average age of (82.4±7.2) years old ranging from 66 to 95 years old, involving 25 femoral neck fractures and 37 femoral intertrochanteric fractures. There were 65 cases in control group, including 18 males and 47 females, with an average age of (81.4±8.7) years old ranging from 65 to 94 years old, involving 29 femoral neck fractures and 36 femoral intertrochanteric fractures. The visual analogue scale(VAS), minimental state examination (MMSE), observer's assessment of alertness/sedation(OAA/S) scale, modified Bromage score, postoperative complications and general conditions during hospitalization in two groups were observed. The resting and exercise VAS at 30 min after block, anesthesia placement and 6, 24 and 48 h after surgery were lower than those in group C(P<0.05). In group F, MMSE scores at 12 h before surgery, and 1, 3 d after surgery and OAA/S scores at 3 d after surgery were higher than those in group C(P<0.05). The incidence of adverse effects and the number requiring additional analgesia were lower than those in group C(P<0.05). Group F had better perioperative analgesia satisfaction and hospital stay than group C(P<0.05). But there was no significant difference regarding Bromage score and 30-day mortality between two group(P>0.05). Ultrasound-guided continuous fascia iliacus space block was safe and effective for elderly patients with hip fracture, and could significantly reduce perioperative pain, improve postoperative cognitive function, and reduce postoperative complications, thereby shortening hospital stay and improving the quality of life during hospitalization.

Ultrasound-guided fascia iliaca compartment block for pain control in total hip arthroplasty: A systematic review and meta-analysis.

Previous studies have investigated the effectiveness and safety of ultrasound-guided fascia iliaca compartment block (UGFICB) compared to quadratus lumborum block (QLB) for pain management in total hip arthroplasty (THA). However, there is currently a lack of a systematic review specifically addressing this issue. Therefore, the purpose of this study was to conduct a comprehensive analysis and comparison of the efficacy and safety of UGFICB versus QLB for pain management in THA. An extensive search was conducted in various electronic databases, including PUBMED, EMBASE, Cochrane Library, Web of Science, Scopus, China Biomedical Literature Service System, and China National Knowledge Infrastructure. This search encompassed all relevant studies published from the inception of these databases until June 30, 2023. The selected outcomes for analysis included moving and resting visual analogue scale (VAS) scores at 12 hours and 24 hours post-surgery, as well as opioids consumption at 24 hours post-surgery. The Cochrane risk-of-bias tool was utilized to assess the risk of bias in the trials included in the analysis. Statistical analysis was conducted using RevMan 5.4 software. A total of 8 trials, involving 656 patients, were included in this study. The results of the meta-analysis showed no significant differences between the 2 modalities in terms of moving VAS scores (mean difference [MD] = 0.17, 95% confidence interval [CI] [-0.79, 1.14], P = .72) and resting VAS scores (MD = 0.04, 95% CI [-0.27, 0.36], P = .78) at 12 hours post-surgery, and moving VAS scores (MD = 0.27, 95% CI [-0.46, 1.01], P = .47) and resting VAS scores (MD = -0.05, 95% CI [-0.45, 0.35], P = .80) at 24 hours post-surgery. However, there was significant differences in opioids consumption at 24 hours post-surgery (MD = 8.98, 95% CI [2.04, 15.93], P = .01) between the 2 groups. Based on these findings, the study concludes that UGFICB may be more beneficial than QLB for pain management in THA. However, it is important to interpret these results with caution due to certain limitations.

Fascia iliaca compartment block can reduce the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement.

In this study, we aimed to observe the effects of ultrasound-guided fascia iliaca compartment block (FICB) combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement. A total of 84 elderly patients-aged 65-85 years, with American Society of Anesthesiologists physical status III-IV, and scheduled for hip arthroplasty between September 2021 and May 2022-were selected. One or more organs with moderate to severe impairment were included in all patients. The patients were randomly divided into a hypobaric spinal anesthesia group (group C, control group) and an ultrasound-guided FICB combined with hypobaric spinal anesthesia group (group E, experimental group). Group C was given 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia, and group E received ultrasound-guided FICB combined with 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia. The patients were compared using the visual analog scale (VAS) for pain, Harris hip function score, and simple Mini-Mental State Examination (MMSE) scale. Blood β-amyloid (Aβ) and neuronal microtubule-associated protein (tau) levels were measured. We compared intraoperative conditions and post-operative complications between the two groups to assess the effects of FICB combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement. At 1 and 3 days after the operation, patients in group C had significantly higher VAS and lower MMES scores than those in group E. The differences were statistically significant at 1 (P < 0.01) and 3 (P < 0.05) days after the operation. At 1 day after operation, the Harris score of patients in group C was significantly lower than that of patients in group E (P < 0.05). The Aβ and tau levels of patients in group C were significantly higher than those of patients in group E at 1 day after the operation (P < 0.01). The Aβ levels of patients in group C were significantly higher than those of patients in group E at 3 days after the operation (P < 0.05). The intraoperative conditions and post-operative complication rates did not differ significantly between the two groups. At 1 day before and 5 days after the operation, there was no difference in any of the indicators. By lowering pain and managing Aβ and tau protein concentrations, FICB can successfully lower the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement. www.chictr.org.cn, identifier: ChiCTR2100051162.

Comparison of suprainguinal approach with infrainguinal approach of fascia iliaca compartment block for postoperative analgesia.

Fascia iliaca compartment block (FICB) is increasingly being used for anaesthesia and analgesia of the hip, knee and thigh. It can be administered via two ultrasound-guided approaches, suprainguinal and infrainguinal. This study aimed to compare the analgesic efficacy of the suprainguinal approach of FICB with infrainguinal approach of FICB in patients undergoing above knee orthopaedic surgeries. In this single-centre, double-blinded randomised trial, 32 patients undergoing above knee lower limb orthopaedic surgery under spinal anaesthesia were randomised into group I (infrainguinal FICB) and S (suprainguinal FICB). They were given ultrasound-guided FICB with 30 mL 0.2% ropivacaine for postoperative analgesia using the respective approaches. Injection tramadol was administered as a rescue analgesic when Numeric Rating Scale (NRS) ≥4. A blinded observer recorded pain score (NRS) from the initiation of the block every 2 h for 24 h. Time to first rescue analgesia, total duration of analgesia and analgesic consumption, and patient satisfaction score were noted. The mean pain scores were comparable between the two groups at all time intervals till 24 h except at 12 h and 20 h, when pain intensity was significantly less in group S than in group I. Total tramadol consumption was also significantly less in group S. There was no significant difference in time to first rescue analgesia and total duration of analgesia between the two groups. At 24 h, the patient satisfaction score was significantly better in group S. Suprainguinal FICB has superior analgesic efficacy over infrainguinal FICB in terms of reduced pain intensity, reduced 24-h tramadol consumption and better patient satisfaction.

Effect of fascia iliaca compartment block on anterolateral small incision total hip arthroplasty

To compare the effects of simple intraspinal anesthesia and combined fascia iliaca compartment block(FICB) on total hip arthroplasty(THA) through anterior lateral small incision (orthop dische chirurgie München, OCM). From January 2019 to October 2020, patients undergoing unilateral total hip arthroplasty were treated with intraspinal anesthesia combined with ultrasound-guided fascia iliaca compartment block(30 cases in group A) and simple intraspinal anesthesia(30 cases in group B). Two groups were treated with the same intravenous analgesia after operation. The operation time, the amount of bleeding, the peeling degree of middle gluteal muscle, the splitting of greater trochanter of femur, the visual analysis scale (VAS) of hip joint after operation, the abductor muscle strength of quadriceps femoris and hip joint before and 48 hours after operation, and the Harris score of hip joint function after operation were observed and compared between two groups. All patients were followed up for 48 to 62 weeks with an average of (54.2±4.0) weeks. The incision length, operation time and intraoperative bleeding in group A were significantly lower than those in group B (P<0.05). The level of hemoglobin 24 hours after operation in group A was significantly higher than that in group B (P<0.05). The abductor muscle strength of hip joint in group A was significantly higher than that in group B 48 hours after operation (P<0.05). The degree of middle gluteal muscle dissection in group A was significantly lower than that in group B (P<0.05). The VAS of group A at 8, 12 and 24 hours after operation was significantly lower than that of group B (P<0.05);The Harris score in group A was significantly higher than that in group B at 2 and 8 weeks after operation (P<0.05). The application of ultrasound-guided fascia iliaca compartment block in lateral position OCM approach THA can significantly shorten the operation time, reduce the amount of bleeding, reduce the perihip trauma such as the peeling of middle gluteal muscle during operation, and improve the early postoperative pain of patients, which is conducive to the clinical operation of OCM approach and the rapid postoperative recovery of patients.

Abstract No.: ABS1604: A comparative study of bupivacaine versus ropivacaine in preoperative fascia iliaca compartment block in patients posted for proximal femur fracture surgeries under spinal anaesthesia

Background and Aims:Positioning for spinal anaesthesia is challenging in patients with femur/hip fractures as it causes severe pain/distress. Peripheral nerve blocks are safe adjuncts without side-effects of systemic analgesics. This study was conducted to compare the efficacy between bupivacaine and ropivacaine in ultrasound-guided fascia iliaca compartment block (FICB) for positioning of spinal anaesthesia.Methods:70 patients( 35 in each group) of American Society of Anesthesiologists physical class I-III, either sex, aged between 18-70 years, posted for proximal femur surgeries were randomly allocated in two groups. All patients in group B received 30ml of 0.25%bupivacaine and in groupR 30ml of 0.25%ropivacaine was administered for FICB.. Onset of sensory block was noted every two minutes using pinprick method. Fifteen minutes later spinal anaesthesia was performed with 0.5% hyperbaric bupivacaine in sitting position. Analgesia during positioning was assessed. The quality of patient positioning for spinal anaesthesia was recorded. Vitals were monitored before(baseline) and after block for every 5minutes until 15minutes. The time for first rescue analgesic request and 24h opioid consumption was noted.Results:Mean onset of FICB in group B was 6.17±1.403 minutes and group R was 10.51±1.772 minutes which was statistically significant (p value <0.001). There was no significant difference in visual analogue scale(VAS) during positioning and quality of positioning in both groups. Time to first rescue analgesia in group B was 409.71±85.146 minutes and groupR was 445.71±77.736 minutes (p value 0.0069) but the difference was not statistically significant. There was no significant difference in 24hour opioid consumption among the two groups.Conclusion:FICB provides analgesia which helps in positioning of the patient for spinal anaesthesia with bupivacaine having faster onset of action compared to ropivacaine but provides comparable duration of analgesia and 24 hour opioid consumption.

Evaluation of Ultrasound-guided Pre-emptive Fascia Iliaca Compartment Block for Postoperative Analgesia in Femur and Hip Fracture Surgeries: A Randomised Controlled Trial

Introduction: Spinal anaesthesia is the preferred anaesthetic technique for fractures of the hip and femur. Ultrasound-guided Fascia Iliaca Compartment Block (FICB) provides more intense analgesia which can prolong the duration of postoperative analgesia and also mitigate the pain encountered while positioning for spinal anaesthesia. Aim: To evaluate the efficacy of ultrasound-guided pre-emptive FICB in hip and femur fracture surgeries. Materials and Methods: This randomized, double-blinded, clinical study was conducted between May 2019 and December 2019, at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Total 66 patients scheduled for hip and femur fracture surgeries under spinal anaesthesia were randomly divided into two groups i.e, group A received Ultrasound-Guided (UG) FICB preoperatively and group B received no block. All the patients received fentanyl 1 mcg/kg intravenous (i.v.) 15 min before spinal anaesthesia. The anaesthesiologist performing spinal anaesthesia graded the score of positioning as 0 as not satisfactory, 1 as satisfactory, 2 as good, 3 as optimal. The time for the first request for analgesia, consumption of analgesics and Visual Analog Scale (VAS) scores for 24 hours postoperatively and any adverse effects were compared between the two groups. Student’s t-test was used to compare continuous data and unpaired t-test for categorical data. Results: The time for the first request for analgesia was 671.52±66.73 min in group A and 480.3±57.65 min in group B and was statistically significant (p-value &lt;0.0001). In group A, the quality of positioning for spinal anaesthesia was optimal in 13 and good in 14 patients. In group B, it was unsatisfactory in 12 and just satisfactory in four patients (p-value=0.0009). Majority of the patients (24) in group A required three doses of paracetamol, while 26 patients required two doses for group B. The total number of doses for tramadol was 4 in group A, and 17 in group B. The VAS scores were reduced at the 8th and 10th hours following surgery in group A. No adverse effects were encountered in the study. Conclusion: The FICB prolongs the time to first request for analgesia postoperatively, improves patient positioning for spinal anaesthesia, reduces the consumption of analgesics, and improves VAS scores postoperatively without any adverse effects.

The Effects of Ultrasound-Guided Fascia Iliaca Compartment Block for Perioperative Analgesia and Rehabilitation in Elderly Patients Undergoing Total Hip Arthroplasty

The Effects of Ultrasound-Guided Fascia Iliaca Compartment Block for Perioperative Analgesia and Rehabilitation in Elderly Patients Undergoing Total Hip Arthroplasty