Efficiency of fascia iliaca block in total hip arthroplasty

Introduction. The present study examined the effect of iliac fascia blockade in patients after primary total hip arthroplasty (TEH).

Purpose. Evaluation of the efficacy and safety of using the iliac fascia blockade in the postoperative period after TEH.

Materials and methods. The study included 60 patients who underwent primary TEH. Patients were randomly divided into two groups: group 1 (n = 30) – patients who underwent a multimodal scheme of postoperative analgesia in the postoperative period; group 2 (n = 30) – patients who, in addition to multimodal analgesia, underwent blockade of the iliac fascia of the thigh under ultrasound navigation after surgery. In the postoperative period, the level of pain syndrome at rest and during movement was recorded using a visual analog scale of the pain level (VAS 1 and VAS 2) after 6–12–24–48 hours. We also recorded the frequency and quantity of prescription of narcotic analgesics and noted the frequency of side effects from their use.

Results. The level of pain syndrome at rest and during movement in the first 24 hours was lower in patients of the 2nd group. After 48 hours, there were no significant differences between the groups in the level of pain. Patients in group 1 were prescribed opioid analgesics more often than patients in group 2. The number of side effects from the use of narcotic analgesics was greater in patients of group 1.

Conclusions. The use of the iliac fascia block is an effective method of perioperative analgesia after hip arthroplasty. This method allows achieving a high level of pain relief and reduces the need for prescription of opioid analgesics.

1. Learmonth I.D., Young C., Rorabeck C. The operation of the century: Total hip replacement. Lancet. 2007; 370: 1508–1519. DOI: 10.1016/S0140–6736(07)60457–7.

2. National Institutes of Health NIH consensus conference: Total hip replacement. NIH consensus development panel on total hip replacement. JAMA. 1995; 273: 1950–1956. DOI: 10.1001/jama.273.24.1950.

3. Kane R. L., Saleh K. J., Wilt T. J., Bershadsky B., Cross W. W., MacDonald R.M., Rutks I. Total knee replacement. Evid. Rep. Technol. Assess. 2003; 86: 1–8.

4. Laupacis A., Bourne R., Rorabeck C., Feeny D., Wong C., Tugwell P., Leslie K., Bullas R. The effect of elective total hip replacement on health-related quality of life. J. Bone Jt. Surg. 1993; 75: 1619–1626. DOI: 10.2106/00004623–199311000–00006.

5. Felson D. T. The epidemiology of knee osteoarthritis: Results from the Framingham Osteoarthritis Study. Semin. Arthritis Rheum. 1990; 20: 42–50. DOI: 10.1016/0049– 0172(90)90046-I.

6. Mamlin L.A., Melfi C.A., Parchman M. L., Michael L., Benjamin G., Deborah I., Barry P.K., Robert S.D., David A.H., Deborah A., et al. Management of osteoarthritis of the knee by primary care physicians. Arch. Fam. Med. 1998; 7: 563–567. DOI: 10.1001/archfami.7.6.563.

7. Kopp S. L., Børglum J., Buvanendran A. More anesthesia and analgesia practice pathway options for total knee arthroplasty: An evidence-based review by the American and European societies of regional anesthesia and pain medicine. Reg. Anesth. Pain Med. 2017; 42: 683–697. DOI: 10.1097/AAP.0000000000000673.

8. Memtsoudis S. G., Sun X., Chiu Y. L., Stundner O., Spencer S. L., Banerjee S., Mazumdar M., Nigel E. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013; 118: 1046–1058. DOI: 10.1097/ALN.0b013e318286061d.

9. Misiołek H., Zajączkowska R., Daszkiewicz A., Woroń J., Dobrogowski J., Wordliczek J., Owczuk R. Postoperative pain management – 2018 consensus statement of the section of regional anaesthesia and pain therapy of the polish society of anaesthesiology and intensive therapy, the polish society of regional anaesthesia and pain therapy, the polish association for the study of pain and the national consultant in anaesthesiology and intensive therapy. Anaesthesiol. Intensive Ther. 2018; 50: 173–179.

10. Opperer M., Danninger T., Stundner O., Memtsoudis S.G. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence-based review. World J. Orthop. 2014; 5: 336–343. DOI: 10.5312/wjo.v5.i3.336.

11. Husted H., Hansen H.C., Holm G., Bach-Dal C., Rud K., Lande Andersen K., Kehlet H. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch. Orthop. Trauma Surg. 2010; 130: 263–268. DOI: 10.1007/s00402–009–0940–7.

12. Kerr D.R., Kohan L. Local infiltration analgesia: A technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients. Acta Orthop. 2008; 79: 174–183. DOI: 10.1080/17453670710014950.

13. Steenberg J., Moller A.M. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br. J. Anaesth. 2018; 120: 1368–1380. DOI: 10.1016/j.bja.2017.12.042.

14. Vaughan B., Manley M., Stewart D., Iyer V. Distal injection site may explain lack of analgesia from fascia iliaca block for total hip. Reg. Anesth. Pain Med. 2013; 38: 556–557. DOI: 10.1097/AAP.0000000000000011.

15. Hebbard P., Ivanusic J., Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: A cadaveric evaluation of a novel approach. Anaesthesia. 2011; 66: 300–305. DOI: 10.1111/j.1365–2044.2011.06628.x.

16. Swenson J.D., Davis J. J., Stream J.O., Crim J.R., Burks R. T., Greis P.E. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: The pattern of distribution and effects on the obturator nerve. J. Clin. Anesth. 2015; 27: 62–67. DOI: 10.1016/j.jclinane.2015.07.001.

17. Liu S. S., Buvanendran A., Rathmell J. P., Sawhney M., James J. B., Moric M., Stephen P., Ashley J.P., Lazaros P., Craig J.D.V., et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int. Orthop. 2012; 36: 2261–2267. DOI: 10.1007/s00264–012–1623–5.

18. Hong H.K., Ma Y. The efficacy of fascia iliaca compartment block for pain control after hip fracture: A meta-analysis. Medicine. 2019; 98: e16157. DOI: 10.1097/ MD.0000000000016157.

19. Haines L., Dickman E., Ayvazyan S., Pearl M., Wu S., Rosenblum D., Likourezos A. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. J. Emerg. Med. 2012; 43: 692–697. DOI: 10.1016/j. jemermed.2012.01.050.

20. Desmet M., Vermeylen K., Van Herreweghe I., Carlier L., Soetens F., Lambrecht S., Croes K., Pottel H., Van de Velde M. A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty. Reg Anesth. Pain Med. 2017; 42: 327–333. DOI: 10.1097/AAP.0000000000000543.

21. Zhang X.Y., Ma J.B. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: A meta-analysis. J. Orthop. Surg. Res. 2019; 66: 89–98. DOI: 10.1186/s13018–018–1053–1.

22. 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: 152–157.

23. Ayoo K., Mikhaeil J., Huang A., Wąsowicz M. The opioid crisis in North America: Facts and future lessons for Europe. Anaesthesiol Intensive Ther. 2020; 52: 139–147. DOI: 10.5114/ait.2020.94756.

24. Gao Y., Tan H., Sun R., Zhu J. Fascia iliaca compartment block reduces pain and opioid consumption after total hip arthroplasty: A systematic review and meta-analysis. Int. J. Surg. 2019; 65: 70–79. DOI: 10.1016/j.ijsu.2019.03.014.

25. Zhang X.Y., Ma J.B. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: A meta-analysis. J. Orthop. Surg. Res. 2019; 66: 89–98. DOI: 10.1186/s13018–018–1053–1.