Effectiveness of lateral femoral cutaneous and femoral nerve block in managing postoperative pain for hemiarthroplasty patients
DOI:
https://doi.org/10.3329/bsmmuj.v18i1.76604Keywords:
fascia iliaca compartment block, lateral femoral cutaneous nerve block, femoral nerve block, hemiarthroplastyAbstract
Background: The fascia iliaca compartment block is commonly used for postoperative analgesia after hemiarthroplasty. However, the method often fails to adequately manage pain due to frequent sparing of the lateral femoral cutaneous nerve. This randomised controlled study was conducted to compare the efficacy of lateral femoral cutaneous and femoral nerve blocks compared to fascia iliaca compartment block for postoperative pain management following hemiarthroplasty.
Methods: Sixty patients were randomly assigned to either the fascia iliaca compartment (FIC) block group or the lateral femoral cutaneous nerve and femoral nerve (LFCN plus FN) block group. All patients received a subarachnoid block for surgery. Pain was assessed using a visual analogue scale (VAS) in the recovery room. When patients reported VAS score 3 or 4, the FIC and LFCN plus FN blocks were performed according to group allocation. VAS scores were reassessed 20 minutes after the blocks and recorded. Subsequently, the pain was assessed using VAS at two-hour intervals until the patients required rescue analgesia.
Results: The VAS scores differed significantly between the two groups. In the LFCN plus FN block group, 13.3% reported VAS 0, 30% reported VAS 1, and the rest reported VAS 2. In the FIC block group, 53.3% reported VAS 2, and 46.7% reported VAS 3. None reported VAS 0 in the FIC group. The average time to demand rescue analgesia was 4.9 (0.8) hours in the FIC group and 9.4 (1.5) hours in the LFCN plus FN group. Adjusted time based on age, sex, body mass index, and Anesthesiologists class for the FIC block group was 6.8 (0.9) hours, while the LFCN plus FN block group recorded 7.5 (0.8) hours (P=0.003).
Conclusion: Administering the LFCN and FN block separately but simultaneously provides better postoperative analgesia than the conventional FIC block following hemiarthroplasty.
Downloads
461
68 PDF
80 Review report
35
References
Kang H, Ha YC, Kim JY, Woo YC, Lee JS, Jang EC. Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture: a randomized, controlled study. J Bone Joint Surg Am. 2013 Feb 20;95(4):291-296. DOI: https://doi.org/10.2106/JBJS.K.01708
A’Court J, Lees D, Harrison W, Ankers T, Reed MR. Pain and Analgesia Requirements With Hip Fracture Surgery. Orthop Nurs. 2017 May/Jun;36(3):224-228. DOI: https://doi.org/10.1097/NOR.0000000000000347
Layzell M. Exploring pain management in older people with hip fracture. Nurs Times. 2009 Jan 20-26;105(2):20-23. PMID: 19260264
Baldo BA. Toxicities of opioid analgesics: respiratory depression, histamine release, hemodynamic changes, hypersensitivity, serotonin toxicity. Arch Toxicol. 2021 Aug;95(8):2627-2642. DOI: https://doi.org/10.1007/s00204-021-03068-2
Bohringer C, Astorga C, Liu H. The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It. Transl Perioper Pain Med. 2020;7(1):152-157. PMID: 31712783
Feng T, Zhao J, Wang J, Sun X, Jia T, Li F. Anesthetic Effect of the Fascia Iliaca Compartment Block with Different Approaches on Total Hip Arthroplasty and Its Effect on Postoperative Cognitive Dysfunction and Inflammation. Front Surg. 2022 May 4;9:898243. DOI: https://doi.org/10.3389/fsurg.2022.898243
Huh JW, Park MJ, Lee WM, Lee DH. Effectiveness of Ultrasound-guided Single-injection Triple Nerve Block Before Cementless Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures. Hip Pelvis. 2020 Sep;32(3):142-147. DOI: https://doi.org/10.3390/10.5371/hp.2020.32.3.142
Dolan J, Williams A, Murney E, Smith M, Kenny GN. Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Reg Anesth Pain Med. 2008 Nov-Dec;33(6):526-531. DOI: https://doi.org/10.1016/j.rapm.2008.03.008
Hadzic A. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd ed. New York: McGraw-Hill Education; 2017. Available at: https://accessanesthesiology.mhmedical.com/book.aspx?bookID=2070#157596497
Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, Harris JD. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018 Mar 23;2(3):e088. DOI: https://doi.org/10.5435/JAAOSGlobal-D-17-00088
Barikdar A, Ahmed T, and Lasker SP. The Situation of the Elderly in Bangladesh. Bangladesh Journal of Bioethics. 2016 Aug; 7(1): 27-36. DOI: https://doi.org/10.3329/bioethics.v7i1.29303
Gola W, Bialka S, Owczarek AJ, Misiolek H. Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomised, Controlled Study. Int J Environ Res Public Health. 2021 May 4;18(9):4891. DOI: https://doi.org/10.3390/ijerph18094891
Shariat AN, Hadzic A, Xu D, Shastri U, Kwofie K, Gandhi K, McCally CM, Gratenstein K, Vandepitte C, Gadsden J, Unis D. Fascia lliaca block for analgesia after hip arthroplasty: a randomized double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2013 May-Jun;38(3):201-205. DOI: https://doi.org/10.1097/AAP.0b013e31828a3c7c
Helayel PE, Lobo G, Vergara R, Conceição DB, Oliveira Filho GR. Volumes efetivos de anestésicos locais para o bloqueio do compartimento da fáscia ilíaca: estudo comparativo duplamente encoberto entre ropivacaína a 0,5% e bupivacaína a 0,5% [Effective volume of local anesthetics for fascia iliac compartment block: a double-blind, comparative study between 0.5% ropivacaine and 0.5% bupivacaine.]. Rev Bras Anestesiol. 2006 Oct;56(5):454-460. Portuguese. DOI: https://doi.org/10.1590/s0034-70942006000500003
Vermeylen K, Soetens F, Leunen I, Hadzic A, Van Boxtael S, Pomés J, Prats-Galino A, Van de Velde M, Neyrinck A, Sala-Blanch X. The effect of the volume of supra-inguinal injected solution on the spread of the injectate under the fascia iliaca: a preliminary study. J Anesth. 2018 Dec;32(6):908-913. DOI: https://doi.org/10.1007/s00540-018-2558-9
Bang S, Chung J, Jeong J, Bak H, Kim D. Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty: A prospective, randomized trial. Medicine (Baltimore). 2016 Sep;95(39):e5018. DOI: https://doi.org/10.1097/MD.0000000000005018
Mahajan A, Derian A. Local Anesthetic Toxicity. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499964
Borozdina A, Qeva E, Cinicola M, Bilotta F. Perioperative cognitive evaluation. Curr Opin Anaesthesiol. 2018 Dec;31(6):756-761. DOI: https://doi.org/10.1097/ACO.0000000000000658
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Kazi Mahzabin Arin, Shofina Sultana, Ayesha Sultana, Abdul Hannan Mohammad, Chandra Shekhar Karmakar, AKM Akhtaruzzaman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
