Clinical Study Of Ultrasound-guided Modified Fascia Iliaca Compartment Block For Analgesia In Elderly Patients Undergoing Total Hip Arthroplasty

Background: With an increasingly aging population,the number of elderly patients undergoing total hip arthroplasty(THA)is also increasing.It is known to all that these patients are often accompanying with severe pain postoperatively.So,it has become the focus of both anesthesiologists and patients that how to relieve the postoperative pain and promote the postoperative rehabilitation of patients.Several studies have reported that the fascia iliaca compartment block(FICB)could provide safely and effectively block for the branch of lumbar plexus,have satisfied analgesia in patients with hip fractures,reduce opioid consumption and opioid-related complications and be beneficial to early activity and rapid rehabilitation postoperatively.However,previous descriptions of an ultrasound-guided FICB emphasized injection of local anesthetic inferior to the inguinal ligament,relying on supra-inguinal spread to block the branch of lumbar plexus in the iliac fossa.However,there are still great objections to the effectiveness of analgesia on this technique.In recent years,the studies of modified FICB have gradually increased in order to improve the success rate of block the branch of lumbar plexus especially the obturator nerve.In this study,we describe a suprainguinal FICB technique and the primary purpose of this study is to observe the analgesia of this modified approach in THA,assess the value of a modified suprainguinal approach in facilitating enhanced recovery after surgery and to explore a better alternative to accelerate the recovery of elderly patients after THA.Methods: A total of 116 elderly patients undergoing direct anterior approach THA were recruited and allocated randomly to two groups: modified FICB group(group S,n=58): 30 ml of 0.3% ropivacaine;and control group(group C,n=58): equal amount of saline.The primary outcomes were resting and initiative visual analogue scale(RVAS/IVAS)at 24 h postoperatively,total opioid consumption intraoperatively and 24 h postoperatively,and length of stay(LOS)postoperatively.The secondary outcomes were RVAS/IVAS and total morphine consumption at 4h,48 h and 72 h postoperatively,the success rates of sensory and motor blockade,patient satisfaction,the postoperative nausea and vomiting(PONV),and postoperative complications of FICB.Results: 116 patients aged 65 to 95 years old were enrolled and 111 patients were included in the statistical analysis finally.Mean [SD] RVAS and IVAS at 24 h postoperatively were lower in group S than in group C(2.30 [0.70] vs.3.30 [0.90],2.70 [1.20] vs.4.50 [1.30],P<0.05).Opioid consumption was significantly lower in group S than in group C during the operation(10.25 [6.10] vs.48.00 [8.53])and at 24h(61.86 [13.23] vs.104.80 [15.00],P<0.05)postoperatively.LOS postoperatively was significant shorter in group S than in group C(5.93 [1.87] days vs.6.91 [1.95] days,P<0.05).The incidence of PONV was significantly lower in Group S than in group C: 1.8% vs.15%.(P<0.05)We reported success rates for the FN,LFCN and ON of 54(96%),52(93%)and 39(69%),respectively.Patient satisfaction was noted and no differences were found between two groups.(P>0.05)And none of the patients developed any complications of FICB such as nerve injury and local anesthetic toxicity.Conclusions: The modified ultrasound-guided suprainguinal FICB is safe and reliable for providing effective analgesia for elderly patients after hip surgery,promotes postoperative rehabilitation,shorten length of stay and deserves further clinical investigation.