Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.07.006
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of the suprainguinal fascia iliaca compartment block with continuous epidural analgesia in patients undergoing hip surgeries: a retrospective study

Comparação do bloqueio do compartimento da fáscia ilíaca suprainguinal com analgesia peridural contínua em pacientes submetidos a cirurgias de quadril: um estudo retrospectivo

Mustafa Azizoğlu; Şebnem Rumeli Atıcı

Downloads: 1
Views: 330

Abstract

Background and objective
Pain control is one of the major concerns after major hip surgeries. Suprainguinal fascia iliaca compartment block (S-FICB) is an alternative analgesic technique that can be considered as an effective and less invasive method than epidural analgesia (EA). In this retrospective study, we compared postoperative analgesic efficacy of single shot ultrasound guided S-FICB and EA after major hip surgery.

Methods
We retrospectively examined 150 patients who underwent major hip surgeries and who received S-FICB or EA. 72 patients were submitted to EA and 78 patients received S-FICB wereincluded and their medical records retrospectively reviewed. Morphine consumptions, VAS scores and side effects were recorded. Patients under antiplatelet or anticoagulant theraphy were also registered. Morphine consumption and VAS scores were the primary endpoints, succes rate and complications were the secondary endpoints of our study. P-values less than 0.05 were considered statistically significant.

Results
Morphine consumption was lower at the emergence in the EA group but there was no statistically significant difference between the two groups according to total opioid consumption (0 [0-0] vs 0 [0-0];p = 0.52). There was no difference between VAS scores in the first 18 hours. Hypotension was significantly higher in the EA group (9 vs 21; p =  0.04).

Conclusion
In conclusion, S-FICB can provide comparable analgesia with EA in the early postoperative period after hip surgery but VAS scores were found lower in the EA group than S-FICB group after 18th hour. Hypotension has occured more frequently in patients receiving EA.

Keywords

Hip arthroplasty;  Nerve blocks;  Epidural analgesia

Resumo

Justificativa e objetivo: O controle da dor é uma das principais preocupações após grandes cirurgias do quadril. O bloqueio do compartimento da fáscia ilíaca suprainguinal (S-FICB) é uma técnica analgésica alternativa que pode ser considerada um método eficaz e menos invasivo que a analgesia epidural (AE). Neste estudo retrospectivo, comparamos a eficácia analgésica pós-operatória de S-FICB guiado por ultrassom e EA após grande cirurgia de quadril. Métodos: Examinamos retrospectivamente 150 pacientes submetidos a grandes cirurgias de quadril e que receberam S-FICB ou EA. 72 pacientes foram submetidos a EA e 78 pacientes receberam S-FICB foram incluídos e seus prontuários revisados retrospectivamente. Consumos de morfina, pontuações EVA e efeitos colaterais foram registrados. Pacientes em terapia antiplaquetária ou anticoagulante também foram registrados. O consumo de morfina e os escores EVA foram os desfechos primários, a taxa de sucesso e as complicações foram os desfechos secundários de nosso estudo. Valores de p inferiores a 0,05 foram considerados estatisticamente significativos. Resultados: O consumo de morfina foi menor na emergência no grupo EA, mas não houve diferença estatisticamente significativa entre os dois grupos de acordo com o consumo total de opioides (0 [0-0] vs 0 [0-0]; p = 0,52). Não houve diferença entre os escores EVA nas primeiras 18 horas. A hipotensão foi significativamente maior no grupo EA (9 vs 21; p = 0,04). Conclusão: Em conclusão, S-FICB pode fornecer analgesia comparável com EA no pós-operatório imediato após cirurgia de quadril, mas os escores VAS foram encontrados mais baixos no grupo EA do que no grupo S-FICB após 18 horas. Hipotensão ocorreu com mais frequência em pacientes recebendo EA.

Palavras-chave

Artroplastia de quadril; Bloqueios de nervos; Analgesia epidural

References

1 T.J. Duellman, C. Gaffigan, J.C. Milbrandt, et al. Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty Orthopedics., 32 (2009), p. 167

2 F.J. Singelyn, T. Ferrant, M.F. Malisse, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty Reg Anesth Pain Med., 30 (2005), pp. 452-457

3 Y. Gao, H. Tan, R. Sun, et al. Fascia iliaca compartment block reduces pain and opioid consumption after total hip arthroplasty: A systematic review and meta-analysis IJS., 65 (2019), pp. 70-79

4 G. Joshi, K. Gandhi, N. Shah, et al. Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities J Clin Anesth., 35 (2016), pp. 524-529

5 J.E. Chelly, D. Ghisi, A. Fanelli Continuous peripheral nerve blocks in acute pain management Br J Anaesth., 105 (Suppl 1) (2010), pp. i86-96

6 T.T. Horlocker, E. Vandermeuelen, S.L. Kopp, et al. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition) Reg Anesth Pain Med., 43 (2018), pp. 263-309

7 P. Hebbard, J. Ivanusic, S. Sha Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach Anaesthesia., 66 (2011), pp. 300-305

8 M. Desmet, K. Vermeylen, I. Van Herreweghe, et al. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty Reg Anesth Pain Med., 42 (2017), pp. 327-333

9 K.R. Milligan, P.N. Convery, P. Weir, et al. The Efficacy and Safety of Epidural Infusions of Levobupivacaine With and Without Clonidine for Postoperative Pain Relief in Patients Undergoing Total Hip Replacement Anesth Analg., 91 (2000), pp. 393-397

10 M.T. Stevanovska, V. Durnev, M.J. Srceva, et al. Continuous femoral nerve block versus fascia iliaca compartment block as postoperative analgesia in patients with hip fracture Pril (Makedon Akad Nauk Umet Odd Med Nauki)., 35 (2014), pp. 85-93

11 Y. Takeda, S. Fukunishi, S. Nishio, et al. Evaluating the Effect of Intravenous Acetaminophen in Multimodal Analgesia After Total Hip Arthroplasty: A Randomized Controlled Trial J Arthroplasty., 34 (2019), pp. 1155-1161

12 J. Steenberg, A.M. Møller Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation Br J Anaesth., 120 (2018), pp. 1368-1380

13 D. Rashwan Levobupivacaine patient controlled analgesia: Epidural versus blind fascia iliaca compartment analgesia – A comparative study EgJA., 29 (2013), pp. 155-159

14 N.G.E. Nooh, A.M.S. Hamed, A.A. Moharam, et al. A comparative study on combined general anesthesia with either continuous fascia iliaca block or epidural anesthesia in patients undergoing lower limb orthopedic surgeries Ain-Shams J Anesthesiol., 9 (2016), pp. 76-82

15 B. Dalens, G. Vanneuville, A. Tanguy Comparison of the fascia iliaca compartment block with the 3-in-1 block in children Anesth Analg., 69 (1989), Article 705Y713

16 K. Kumar, R.K. Pandey, A.P. Bhalla, et al. Comparison of conventional infrainguinal versus modified proximal suprainguinal approach of Fascia Iliaca Compartment Block for postoperative analgesia in Total Hip Arthroplasty. A prospective randomized study Acta Anaesthesiol Belg., 66 (2015), pp. 95-100

17 C.M. O’Donnell, L. McLoughlin, C.C. Patterson, et al. Perioperative outcomes in the context of mode of anaesthesia for patients undergoing hip fracture surgery: systematic review and meta-analysis Br J Anaesth., 120 (2018), pp. 37-50

18 P. Choi, M. Bhandari, J. Scott, et al. Epidural analgesia for pain relief following hip or knee replacement Cochrane Database Syst Rev., 3 (2003), Article CD003071

19 A.F. Davies, E.P. Segar, J. Murdoch, et al. Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty Br J Anaesth., 93 (2004), pp. 368-374

20 S.J. Fowler, J. Symons, S. Sabato, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials Br J Anaesth., 100 (2008), pp. 154-164

21 T. Tetsunaga, T. Sato, N. Shiota, et al. Comparison of Continuous Epidural Analgesia, Patient-Controlled Analgesia with Morphine, and Continuous Three-in-One Femoral Nerve Block on Postoperative Outcomes after Total Hip Arthroplasty Clin Orthop Surg., 7 (2015), pp. 164-170

22 L.B. Ready Acute pain: lessons learned from 25,000 patients Reg Anesth Pain Med., 24 (1999), pp. 499-505

23 J. Hermanides, M.W. Hollmann, M.F. Stevens, et al. Failed epidural: causes and management Br J Anaesth., 109 (2012), pp. 144-154

24 M. Behrends, E.N. Yap, A.L. Zhang, et al. Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial Anesthesiology., 129 (2018), pp. 536-543

25 M. Heesen, J. Bohmer, S. Klohr, et al. The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor, maternal, and neonatal outcomes: a systematic review and meta-analysis Anesth Analg., 121 (2015), pp. 149-158

26 A. Bullingham, S. Liang, E. Edmonds, et al. Continuous epidural infusion vs programmed intermittent epidural bolus for labour analgesia: a prospective, controlled, before-and-after cohort study of labour outcomes Br J Anaesth., 121 (2018), pp. 432-437

27 G. Cappelleri, P. Ferrua, M. Berruto The Impact of Anesthesia and Surgical Exposure on Quadriceps Muscle Function Orthop Muscul Syst., 3 (2014), p. 147

28 A. Ahmed, T. Baig Incidence of lower limb motor weakness in patients receiving postoperative epidural analgesia and factors associated with it: An observational study Saudi J Anaesth., 10 (2016), pp. 149-153

29 K.C. Roberts, W.T. Brox, D.S. Jevsevar, et al. Management of Hip Fractures in the elderly JAAOS., 23 (2015), pp. 131-137

30 C.R. Almeida, E.M. Francisco, V. Pinho-Oliveira, et al. Fascia iliaca block associated only with deep sedation in high-risk patients, taking P2Y12 receptor inhibitors, for intramedullary femoral fixation in intertrochanteric hip fracture: a series of 3 cases J Clin Anesth., 35 (2016), pp. 339-345

6107f701a9539540f22cdd62 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections