Ultrasound Guided Longitudinal Supra-Inguinal Fascia Iliaca Block for Hip Surgeries- A Prospective Study

Author(s): Rajasekhar Thondamanati1 , Subhashree Jayaraman2 , Madhusalini Kondapalli3 , Pradeep Kumar Koramutla4

BACKGROUND Hip fractures are very common in geriatric population with incidence increasing every year because of increased life expectancy. Effective postoperative pain management can result in early ambulation and reduced hospital stay. Peripheral nerve block techniques have been widely used for providing postoperative analgesia because of their less systemic effects among which, fascia iliaca compartment block will provide complete analgesia in hip surgeries as it blocks both femoral and lateral femoral cutaneous nerves. METHODS We conducted this case series to evaluate the analgesic efficacy of ultrasound guided suprainguinal fascia iliaca block with 30 ml of 0.25% bupivacaine with 0.5 µg/Kg dexmedetomidine. After obtaining institutional ethics committee and written informed consent, we included 50 patients belonging to ASA PS1, 2 posted for various hip surgeries. Patients who did not give consent and patients with history of coagulopathy were excluded from the study. All patients underwent the procedure under spinal anaesthesia. Once the procedure was over, patient was shifted to postoperative ICU, under sterile aseptic precautions, and ultrasound guided suprainguinal fascia iliaca block was given. Postoperative analgesia was assessed using VAS scale and patient’s satisfaction using Likert’s satisfaction score at 20 minutes, 6th hour, 12th hour, and 24th hour. Rescue analgesia was given with tramadol 0.5-1 mg/Kg when the VAS score was more than 4 and the total dose given in the 24 hours was noted. RESULTS We found that VAS score (ANOVA test) was less at 20 minutes, 6th hour and 12th hour (p < 0.001), which was statistically significant, and less rescue analgesic was required. Hence, we concluded that suprainguinal fascia iliaca block provides effective analgesia for hip procedures in elderly patients. CONCLUSIONS Suprainguinal fascia iliaca compartment block with 30 ml of 0.25% bupivacaine with 0.5 µg/Kg dexmedetomidine provides effective and prolonged analgesia with less rescue analgesic requirement and less systemic effects.