A Randomized and Observer Blinded Comparison of Continuous Femoral Block and Fascia Iliaca Compartment Block in Hip Replacement Surgery

Abstract

IntroductionPain after hip replacement surgery may potentially hinder postoperative physiotherapy and early mobilisation. Regional anesthesia of the lower limb appears to be effective for postoperative pain control [1] in this setting and it has been shown that the lumbar plexus blockade provides high-quality analgesia [2], as the femoral nerve supplies the anterior hip joint capsule, as well as the proximal femur, the quadriceps, iliacus and pectineus muscles.The most common approach is the femoral perivascular technique with a peripheral nerve stimulator [3]. Several studies have demonstrated that this approach does not achieve a reliable block of all three nerves (femoral nerve, obturator nerve, lateral femoral cutaneous (LFC) nerve) [2]. The femoral (FEM) block fails mostly in areas supplied by the LFC and the obturator nerve. Capdevila and Seeberger have seen a sufficient anesthesia of the LFC by using the femoral block in only 62% [2] respectively 44% [4]. But the LFC nerve may at least in part be responsible for pain in the incisional area of hip surgery.An alternative approach to the FEM block is the fascia iliaca compartment (FIC) block. Anesthesia of the LFC is achieved in 90% by using the FIC block [5]. The puncture site is further from the femoral nerve, laterally, and two are perceived when piercing the facia. Local anesthetic does not only reach the LFC nerve, but also the femoral nerve because the needle tip and the femoral nerve are located in the same compartiment (Figure1). Therefore, the FIC block could provide effective analgesia after hip surgery as an alternative to FEM-block.No prospective trial has been reported yet comparing the two approaches in hip surgery in regard to procedural technique differences, analgesia and functional outcome.The goal of the study was to verify the assumption that the FIC block is less time-consuming to perform but provides equally effective analgesia compared to the FEM block, even with an ad hoc implementation in the clinical routine, as performing the fascia iliaca compartment block was a new procedure in our department and experience with it was barely existent compared to the perivascular FEM block. AbstractBackground: Techniques, analgesic effects and functional outcome of continuous femoral nerve and fascia iliaca compartment blocks were compared in patients undergoing hip replacement surgery.