Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty

Abstract

Background:The fascia iliaca compartment block (FICB) provides an analgesic effect in patients with femur fractures. However, the postoperative pain after hip surgery is different from that after femur fracture, because of the difference in the degree and location of tissue trauma. Whether FICB provides effective postoperative analgesia in patients undergoing total hip arthroplasty is not well understood. Moreover, there is no prospective randomized study to evaluate FICB as a postoperative analgesia in hemiarthroplasty. Therefore, we performed a randomized and prospective study to determine the effect of FICB after hemiarthroplasty. The objective of this study was to compare the opioid consumption between patients who received intravenous patient-controlled analgesia (PCA) with and without FICB.Methods:Twenty-two patients aged 70 to 90 years who underwent bipolar hemiarthroplasty for femoral neck fracture were recruited and allocated randomly into 2 groups: FICB group (n = 11) and Non-FICB group (n = 11). All patients received spinal anesthesia with 10 mg of 0.5% hyperbaric bupivacaine. After surgery, the FICB was conducted using a modified technique with 0.2% ropivacaine (40 mL) under ultrasonographic guidance, and the intravenous PCA was administered to patients in both groups in the separate block room. The PCA was set up in the only bolus mode with no continuous infusion. The visual analog scale (VAS) and the opioid consumption were noted at 4, 8, 12, 24, and 48 hours postoperatively.Results:The VAS was similar in both groups. The fentanyl requirement at 4, 8, and 12 hours was low in the FICB group. The total amount of fentanyl required in the first 24 hours was 246.3 μg in the FICB group and 351.4 μg in the Non-FICB group. No patient developed any residual sensory-motor deficit during the postoperative period. Patients in the Non-FICB group had nausea (n = 2), and pruritus (n = 1), and 1 patient had nausea in the FICB group during postoperative 2 days.Conclusion:The FICB has a significant opioid-sparing effect in first 24 hours after hemiarthroplasty. This suggests that FICB is an effective way for multimodal analgesia in hip surgery.

Fascia iliaca compartment block versus no block for pain control after lower limb surgery: a meta-analysis

“…Of the 7 articles, 1 study each was carried out in Australia, 13 China, 26 Thailand, 27 Korea, 29 Belgium, 30 Greece, 31 and Ethiopia. 4 Our present study involved 252 cases with FICB and 256 cases with NB.…”

Postoperative analgesia for fracture femur using Ultrasound-guided Fascia Iliaca block

“…Bang, et al study found that FICB in hemiarthroplasty has less opioid consumption at 4, 8, and 12hours in the postoperative period, and the total fentanyl consumption during postoperative 24hours was decreased in patients with the FICB which supported our results. 13 Paut, et al noticed the presence of minimal side effects among the FICB study group that was mainly nausea and vomiting. 14 Nie, et al compared the effect of continuous FICB with fentanyl patient control analgesia in patients after hip surgeries found that 2.6 %, suffered pruritus in FICB.…”

Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy

“… 17 Bang et al also performed a prospective, randomized trial of patients who received FICB versus patient-controlled analgesia in postoperative hemiarthroplasty patients and found visual analog scales were similar in both groups; however, opioid use was significantly lower in the block group. 40 A 2002 Cochrane review demonstrated appropriately based nerve block reduced the amount of oral and parenteral analgesics postoperatively. 41 Foss et al performed a double-blinded study where 1.0% mepivacaine was injected into the fascia iliaca block versus normal saline and found a reduction in opioid consumption in the fascia iliac block cohort.…”