Applications and Critical Evaluation of Fascia Iliaca Compartment Block and Quadratus Lumborum Block for Orthopedic Procedures

Abstract

Anterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). one of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (fiCb) that affects nerves important for hip innervation and sensory innervation of the thigh -femoral, obturator and lateral femoral cutaneous nerve. fiCb can be easily performed and is often a good solution for management of hip fractures in emergency departments. its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. quadratus lumborum block (qlb) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior qlb has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. however, some nerve branches responsible for innervation of the hip joint are not affected by qlb, which has to be taken into consideration. qlb has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach. keywords: hip joint innervation; regional anesthesia; orthopedic surgery; fascia iliaca compartment block; quadratus lumborum block

Comparison of USG-guided or landmark approach fascia iliaca compartment block for positioning in elderly hip fracture patients with spinal anesthesia: a randomized controlled observational study

“…The mechanism of this block is blockage of the femoral, lateral femoral cutaneous, and obturator nerves under the fascia iliaca. Sufficient amounts of local anesthetic administered under the fascia iliaca induces block in the compartment under the fascia, even if it spreads somewhat distant from the nerves [20]. In our study, we think that the reason for the anatomic landmark approach FICB block having a similar analgesic effect with USG-guided block is subfascial extension.…”

The efficacy of adding dexmedetomidine perineurally in fascia iliaca compartment block versus intravenously in hip arthroscopy: A randomized controlled trial

“…During patient positioning for spinal anesthesia in femur fracture surgeries, FICB provides better analgesia compared to IV opioids [5], where the fascia iliaca compartment catheter can be placed faster than femoral nerve catheter, but with retarded onset of sensory block [6].…”

Ultrasound-guided fascia iliaca block versus quadratus lumborum block for perioperative analgesia in patients undergoing hip surgery. A randomised controlled trial

“…Fascia iliaca block affects the femoral nerve, obturator nerve, and lateral femoral cutaneous nerve. It can be used for the management of hip fractures in emergency rooms and hip arthroplasties [ 9 ].…”

“…Quadratus lumborum block (QLB) is a relatively new regional technique with a vague mechanism of action used mainly for upper and lower abdominal procedures. Recently many clinical trials have examined its benefits in hip surgery [ 9 ].…”