Ultrasound‐Guided Suprainguinal Fascia Iliaca Technique Provides Benefit as an Analgesic Adjunct for Patients Undergoing Total Hip Arthroplasty

Bullock, W. Michael; Yalamuri, Suraj; Gregory, Stephen H.; Auyong, David B.; Grant, Stuart A.

doi:10.7863/ultra.16.03012

Cited by 37 publications

(35 citation statements)

References 12 publications

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“…It is currently the most widely used peripheral nerve block regimen for postoperative analgesia of the lower limbs. Previous studies con rmed that single or continuous block provides good postoperative analgesia for lower limb surgery, such as for the knee joints [14,[17][18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Suprainguinal fascia iliaca block was performed according to the method described by Bullock et al [14], but was conducted under the guidance of an in-plane. The patient was placed in the supine position, and the position of the anterior superior iliac spine was marked.…”

Section: Methodsmentioning

confidence: 99%

“…This regimen reduces the incidences of postoperative delirium and early postoperative cognitive dysfunction [13]. Bullock et al [14] described superior inguinal ligament fascia iliaca compartment block for the rst time. This new method might block the lateral femoral cutaneous nerve more effectively than the traditional inferior inguinal ligament fascia iliaca compartment block, providing analgesia for incision after total hip arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Suprainguinal Fascia Iliaca Block Accelerates General Anesthesia Recovery and Relieves Postoperative Pain in Elderly Patients After Total Hip Arthroplasty: A Retrospective Study

Wang¹,

Liu²,

Ni³

et al. 2020

Preprint

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Background: Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients receiving total hip arthroplasty. To investigate whether suprainguinal fascia iliaca block accelerates recovery after general anesthesia and relieves early postoperative pain in elderly patients undergoing total hip arthroplasty. Methods: Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at the Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed. The time to tracheal extubation and spent in the post anesthesia care unit (PACU), intraoperative remifentanil dosage, fentanyl consumption in PACU, postoperative cumulative fentanyl consumption within 48 h after operation, visual analog scale (VAS) at rest and during movement on the first and second days after surgery, and adverse reactions were compared.Results: Thirty-one patients were included in the study (block group:16, no-block group: 15). The VAS at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group (all P<0.05). The intraoperative remifentanil dosage, fentanyl consumption given in PACU, and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group (all P<0.01). The time to tracheal extubation and the time spent in PACU in the block group were shorter (all P<0.01). Conclusion: Suprainguinal fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Suprainguinal Fascia Iliaca Block Accelerates General Anesthesia Recovery and Relieves Postoperative Pain in Elderly Patients After Total Hip Arthroplasty: A Retrospective Study

Wang¹,

Liu²,

Ni³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This approach has also been used by Desmet et al 13 and Bullock et al 14. Measurements were performed in the supine position with the operated extremity measured first, followed by the non-operated extremity.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial

Gasanova

Alexander

Estrera

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesFascia iliaca compartment block (FICB) has been shown to provide excellent pain relief in patients undergoing total hip arthroplasty (THA). However, the analgesic efficacy of FICB, in comparison with periarticular infiltration (PAI) for THA, has not been evaluated. This randomized, controlled, observer-blinded study was designed to compare suprainguinal FICB (SFICB) with PAI in patients undergoing THA via posterior approach.MethodsAfter institutional review board approval, 60 consenting patients scheduled for elective THA were randomized to one of two groups: ultrasound-guided SFICB block or PAI. The local anesthetic solution for both the groups included 60 mL ropivacaine 300 mg and epinephrine 150 µg. The remaining aspects of perioperative care, including general anesthetic and non-opioid multimodal analgesic techniques, were standardized. An investigator blinded to group allocation documented pain scores at rest and with movement and supplemental opioid requirements at various time points. Patients were evaluated for sensory changes and quadriceps weakness in the operated extremity.ResultsThere were no differences between the groups with respect to demographics, intraoperative opioid use, duration of surgery, recovery room stay, nausea scores, need for rescue antiemetics, time to ambulation and time to discharge readiness as well as 48 hours postoperative opioid requirements. The pain scores at rest and with movement also were similar at all time points. Significantly more patients in the SFICB group experienced muscle weakness at 6 hours after surgery.ConclusionsUnder the circumstances of our study, in patients undergoing THA, SFICB provided the similar pain relief compared with PAI, but was associated with muscle weakness at 6 hours postoperatively.Trial registration number NCT02658240.

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“…23 This finding was further supported by a more recent study of clinical anesthesia of the lateral thigh. 32 Anesthesia was found in all subjects in a case series of patients receiving a suprainguinal fascia iliaca block. The 100% bilateral success rate of lateral anesthesia after the SI-FIC block performed in the current study additionally adds to the validation of the SI-FIC block to reliably anesthetize the LFC nerve.…”

Section: Clinical Trialmentioning

confidence: 97%

The Lateral Femoral Cutaneous Nerve

Nielsen

Moriggl

Barckman

et al. 2018

Regional Anesthesia and Pain Medicine

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Background and ObjectivesNerve blockade of the lateral femoral cutaneous (LFC) nerve provides some analgesia after hip surgery. However, knowledge is lacking about the extent of the cutaneous area anesthetized by established LFC nerve block techniques, as well as the success rate of anesthetic coverage of various surgical incisions. Nerve block techniques that rely on ultrasonographic identification of the LFC nerve distal to the inguinal ligament can be technically challenging. Furthermore, the branching of the LFC nerve is variable, and it is unknown if proximal LFC nerve branches are anesthetized using the current techniques. The primary aim of this study was to investigate a novel ultrasound-guided LFC nerve block technique based on injection into the fat-filled flat tunnel (FFFT), which is a duplicature of the fascia lata between the sartorius and the tensor fasciae latae muscle, in order to assess the success rate of anesthetizing the proximal LFC nerve branches and covering of the different surgical incisions used for hip surgery.MethodsFirst, a cadaveric study was conducted in order to identify an FFFT injection technique that would provide adequate injectate spread to the proximal LFC nerve branches. Second, a clinical study was conducted in a group of 20 healthy volunteers over 2 consecutive days. On trial day 1, successful complete anesthesia of the LFC nerve was defined by performing a suprainguinal fascia iliaca block bilaterally in each subject. On trial day 2, a triple-blind randomized controlled trial compared the effect of the novel ultrasound-guided LFC nerve block technique for bupivacaine versus placebo. The primary end point was the success rate of anesthesia of the proximal cutaneous area innervated by the LFC nerve for the FFFT injection with bupivacaine versus placebo.ResultsAdequate spread of injectate to the proximal LFC nerve branches in cadavers was obtained by injecting 10 mL with dynamic needle-tip tracking in the FFFT. Application of this technique in the randomized controlled trial provided anesthesia of the lateral thigh with a success rate of 95% (95% confidence interval, 73.9%–99.8%) for the active side and 0% for placebo (P < 0.001). The proximal branches were anesthetized with a success rate of 68% (95% confidence interval, 43.4%–87.4%) on the active side. The proximal extent of the anesthetized cutaneous area was on average 7.9 cm distal to the greater trochanter.ConclusionsThis novel LFC nerve block technique is easy and quick and reliably produces anesthesia of the lateral thigh. The greater trochanter is rarely included in the area of anesthesia, which reduces the coverage of each specific surgical incision. The success rate of 68% in anesthetizing the proximal nerve branches must be further evaluated by future research.

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Ultrasound‐Guided Suprainguinal Fascia Iliaca Technique Provides Benefit as an Analgesic Adjunct for Patients Undergoing Total Hip Arthroplasty

Cited by 37 publications

References 12 publications

Suprainguinal Fascia Iliaca Block Accelerates General Anesthesia Recovery and Relieves Postoperative Pain in Elderly Patients After Total Hip Arthroplasty: A Retrospective Study

Suprainguinal Fascia Iliaca Block Accelerates General Anesthesia Recovery and Relieves Postoperative Pain in Elderly Patients After Total Hip Arthroplasty: A Retrospective Study

Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial

The Lateral Femoral Cutaneous Nerve

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