Clinical Study Of Ultrasound-guided Fascia Iliac Compartment Block

ObjectiveCurrently,ultrasound guided fascia iliac compartment block (FICB) mainlydepends on local anesthetic injection below the inguinal ligament,relying on the grointo arrest the lateral femoral cutaneous nerve(LFCN), femoral nerve and obturator nerve,which are in the iliac fossa.An infra-inguinal local anaesthetic injection must passsuperiorly from the thigh to block these nerves and may therefore require a greatervolume injection. In addition, the proximal LFCN and femoral nerve lie close togetherin the iliac fossa and may be blocked simultaneously by a smaller volume injection. Inorder to provide an appropriate clinical application, the effect of supra-inguinal fasciailiaca compartment block will be investigeted,,furthermore, the analgesic effect ofinfra-inguinal and supra-inguinal fascia iliaca compartment block after the THA will beexplored.MethodsPart one:Select20patients with hip fracture, the ASA Ⅰ~Ⅲ,in the anesthesiapreparation room implementing ultrasound-guided supra-inguinal fascia iliacablock.,with0.25%ropivacaine30ml.Nine points are established in thethigh:firstly,building three horizontal lines which are perpendicular to the vertical axisof the thigh,flat to edge of pubic symphysis levels,patellar level and middle levelbetween this two lines.Then,set up nine points on the lines, the most outside, the mostinside and the middle respectively.Which are a1、b1、c1、a2、b2、c2、a3、b3、c3. After20minutes Fascia iliac Compartment injection, using the acupuncture (20G) tocompare and determinate the blocking effect: blocking completely (no pain), blockinginsufficiency (pain reduction) and non-blocking (pain unchanged). Part two:60patients,the ASA Ⅰ~Ⅲ,scheduled for total hip arthroplasty undersubarachnoid anesthesia were randomly divided into2groups:supra-inguinal fasciailiaca compartment block (group A,n=30) and infra-inguinal fascia iliaca compartmentblock (group B,n=30).The patients in each group were scheduled to receive thecontinuous ultrasound-guided FICB by catheter, which was connected with the PCAdevice. A total volume of20ml different concentrations of ropivacaine was injected bythe catheter. The PCA delivery mode was programmed to deliver10ml ropivacainewith a lockout time of60minutes. The analgesia was continued for72hours. If theRVAS score was above4, the Dynastat40mg should additional used by intravenous.The RVAS scores at the time before the FICB (0h) and3h,6h,12h,24h,48h,72hafter the FICB were recorded. The PVAS scores at12h,24h48h,72h and the IVASscores at12h,24h,48h,72h after the FICB were also recorded. The consumption ofropivacaine at3h,6h,12h,24h,48h,72h. Adverse reactions and patient satisfactions afterthe FICB were also recorded.ResultsPart one:20min after fascia iliac compartment injection, a1、b1、a2、b2completely blockrate were100%; c1was only5percent completely block, a3、c2、c3、b3complete ly block rateincreased, but were not up to100%.Part two: There was no significant difference in the ASA, sex,age,, the bodymass index and the operation time among the four groups (P>0.05). The RVAS score,the PVAS score and the IVAS score were no significant difference (P>0.05); Patientswith nausea and vomiting was low, there was no significant difference between thesetwo groups (P>0.05). Compared with group B, in3h and6h ropivacaine dosage ingroup A were undifferentiated (P>0.05), remaining at each time point with a volumeof less than ropivacaine in group B, the difference was statistically significant (P<0.05),2cases in group A with Dynastat sodium,4cases in group B, the differencebetween groups was not statistically significant (P>0.05). ConclusionsPart one:The ultrasound-guided supra-inguinal FICB with0.25%ropivacaine30ml can block the anterior lateral and medial thigh pain near the calf area,whichis,maybe, an effective postoperative analgesia method for hip and knee surgery.Part two:①The ultrasound-guided continuous FICB with0.25%ropivacaine,both supra-inguinal and infra-inguinal,which can provide good postoperative painrelief,including rest and move,and and low side effects and high patient analgesiasatisfaction, for the THA patients.②Within72hours after surgery，the total localanesthetics volume in supra-inguinal fascia iliaca block is less than the volume ininfra-inguina fascia iliaca block.