Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study

Abstract

Objective: An assessment of the feasibility of fascia iliaca compartment block (FICB) combined with nonopioid analgesics and patient controlled analgesia (PCA), oxycodone, in the perioperative anaesthetic management for elective total hip replacement (THR). Design: A randomised, single-center, open-label study. Setting: A single hospital. The study was conducted from October 2018 to May 2019. Participants: In total, 109 patients were scheduled for elective total hip replacement. Interventions: Postoperative FICB with 0.375% ropivacaine in conjunction with nonopioid analgesics (paracetamol, metamizole, and pregabalin) and oxycodone as rescue analgesia. Measurements: Pain intensity was measured using the Numeric Pain Rating Scale (NRS) at rest and during rehabilitation, the total dose of postoperative oxycodone required, the occurrence of opioid-related adverse events, patient hospitalisation time, and level of satisfaction. Follow-up period: 48 h. Main Results: A total of 109 patients were randomised into two groups and, of these, 9 were subsequently excluded from the analysis (three conversions to general anaesthesia, two failures to perform FICB, four failures to use the PCA pump). Patients in the FICB group received standard intravenous analgesia with FICB, and those in the control group were managed with standard intravenous analgesia only. Pain level measured with NRS was significantly lower at rest and during rehabilitation in the FICB group. Oxycodone use in the first 48 h was significantly higher in the control group (p < 0.001); additionally, the time to the first dose of rescue analgesia was significantly shorter (p < 0.001). In the control group, there was a higher rate of side effects and a significantly longer hospitalisation time (p < 0.001). Similarly, higher satisfaction with the applied analgesic treatment was noted in the FICB group. Conclusions: FICB in elective THR treatments is an effective form of analgesia, which reduces the need for opioids, the number of complications, the length of hospitalisation, and which ensures a high level of patient satisfaction with the analgesic treatment used. Trial registration: ClinicalTrials.gov No. NCT04690647.

The Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Plane Block after Hip Arthroplasty

“…In agreement with this study, Gola et al [18] evaluated the viability of FICB with nonopioid analgesics and patient-controlled analgesia (PCA), in the perioperative anesthetic management for elective total hip replacement. Gola's team disocered that the pain score in FICB group was statistically significantly less than the control group.…”

“…Also, Deniz et al [16], support our results that, no adverse effect as nausea. In addition, Gola et al [18] found insignificant differences in complication.…”

“…They concluded that a modified FICB made a significant morphine-sparing effect in unilateral total hip arthroplasty. Also, Gola et al [18] found that the total consumed dose of opioids, in the FICB group had statistically significantly less than the PCA control group. Also, Kumie et al [8], support our study that, the total analgesic ingesting of diclofenac got decreased in the FICNB group than the control group, and the time for the first analgesic request has significantly prolonged.…”

“…In addition, Gola et al [18] found a greater rate of patient satisfaction with the analgesic treatment use. As regard complication, there was hypotension, bradycardia, nausea & vomiting post dual puncture headache.…”

Anesthetic Effect of the Fascia Iliaca Compartment Block with Different Approaches on Total Hip Arthroplasty and Its Effect on Postoperative Cognitive Dysfunction and Inflammation

“…Needle insertion in the outside FICB approach is directed toward the inside, so that the direction of the inserted catheter is away from the lateral femoral cutaneous nerve, while the needle insertion direction of the inside FICB approach points to the outside, so that the indwelling catheter tip is closer to the lateral femoral cutaneous nerve ( 18 , 19 ). The lateral femoral cutaneous nerve block ratio was higher with less postoperative analgesia ( 20 – 22 ). The lateral femoral cutaneous nerve divides into anterior and posterior branches at about 5 cm below the anterior superior iliac spine, and the posterior branch moves to the posterior and inferior ear, and distributes to the skin near the greater trochanter of the femur.…”