Comparison of the Effectiveness of Suprainguinal Fascia Iliaca Compartment Block and Patient-Controlled Analgesia for Major Hip Surgeries in Elderly Patients

Abstract

Objective Fascia iliaca compartment block is an alternative analgesic technique for hip surgeries. In the new suprainguinal technique, the ‘bowtie’ sign is detected with an ultrasound probe, and local anaesthetic is injected into the fascial plane with in-plane approach. In this retrospective study, we compared the postoperative analgesic efficacy of suprainguinal fascia iliaca compartment block (S-FICB) and patient-controlled analgesia (PCA) after major hip surgery in elderly patients. Methods We retrospectively recorded visual analogue scale (VAS) scores, morphine consumptions and opioid side effects who underwent either a S-FICB (n=67) or PCA (n=61). In the S-FICB group, 25–40 mL of 0.25% bupivacaine was administered with a single-shot S-FICB technique after induction of anaesthesia. VAS scores during resting (VAS-S) and movement (VAS-D); morphine consumption at 0, 6, 12, 24 and 48 hours; total morphine consumption; and opioid-related complications were recorded. Results Morphine consumptions in each measurement period and in total were significantly lower in the S-FICB group (694.03±2,007.47 μg vs. 13,368.85±4,834.68 μg; p<0.05). The total number of opioid-related complications were also significantly lower in the S-FICB group (17/67 vs. 48/62; p<0.05). More than half of the patients (38/67, 56%) did not need morphine administration in the S-FICB group. VAS-S during the first 6 hours and VAS-D up to 24 hours postoperatively were significantly lower in the S-FICB group (p<0.05). Conclusion In our study, S-FICB provided better analgesia than the PCA technique after hip surgery in elderly patients. Moreover, S-FICB reduced opioid consumption and opioid-related complications in the first 24 hours postoperatively.

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

“…Chen et al observed significantly lower visual analog scale (VAS) scores at 6 and 12 hours after procedure with 30 mL of 0.2% ropivacaine in SIFI block in comparison to infrainguinal FICB in 50 patients undergoing hip surgeries [1]. Azizoğlu et al demonstrated significantly lower pain scores at rest till 6 hours and pain scores with movement for up to 24 hours post-operatively with 40 mL of 0.25% bupivacaine in USG SIFI in comparison to patient-controlled analgesia with morphine [2]. Though we found no studies comparing different volumes of drug required for SIFI block, the results of studies evaluating the effective volume for the same were corresponding to ours.…”

“…Adequate pain control is an important part of post-operative care for enhanced recovery after surgery as severe pain may lead to an increased stress response and unanticipated hemodynamic changes, which can then trigger major cardiovascular and cerebrovascular complications such as cerebral hemorrhage and myocardial infarction. Thus, early and aggressive application of safe and effective analgesic modalities is essential to improve the outcomes in these patients, especially for older adults with multiple underlying diseases [1,2].…”