Brazilian Journal of Anesthesiology 2022;72(3):342---349

ORIGINAL INVESTIGATION

Comparison of the suprainguinal fascia iliaca

compartment block with continuous epidural analgesia
in patients undergoing hip surgeries: a retrospective
study
∗
Mustafa Azizoğlu , Şebnem Rumeli

Mersin Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Mersin, Turkey

Received 20 February 2020; accepted 10 July 2021

Available online 26 July 2021

KEYWORDS Abstract
Hip arthroplasty; Background and objective: Pain control is one of the major concerns after major hip surgeries.
Nerve blocks; Suprainguinal fascia iliaca compartment block (S-FICB) is an alternative analgesic technique
Epidural analgesia that can be considered as an effective and less invasive method than epidural analgesia (EA). In
this retrospective study, we compared postoperative analgesic efficacy of single shot ultrasound
guided S-FICB and EA after major hip surgery.
Methods: We retrospectively examined 150 patients who underwent major hip surgeries and
who received S-FICB or EA. Seventy-two patients submitted to EA and 78 patients who received
S-FICB were included and their medical records retrospectively reviewed. Morphine consump-
tions, VAS scores, and side effects were recorded. Patients under antiplatelet or anticoagulant
theraphy were also registered. Morphine consumption and VAS scores were the primary end-
points, succes rate and complications were the secondary endpoints of our study. P-values less
than 0.05 were considered statistically significant.
Results: Morphine consumption was lower at the emergence in the EA group but there was no
statistically significant difference between the two groups according to total opioid consumption
(0 [0-0] vs 0 [0-0]; p = 0.52). There was no difference between VAS scores in the first 18 hours.
Hypotension was significantly higher in the EA group (9 vs 21; p = 0.04).
Conclusion: In conclusion, S-FICB can provide comparable analgesia with EA in the early post-
operative period after hip surgery but VAS scores were found lower in the EA group than S-FICB
group after 18th hour. Hypotension has occured more frequently in patients receiving EA.
© 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. This
is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

∗ Corresponding author.
E-mails: dryalamaoglu@hotmail.com, drazizoglu@mersin.edu.tr (M. Azizoğlu).

https://doi.org/10.1016/j.bjane.2021.07.006
© 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 Brazilian Journal of Anesthesiology 2022;72(3):342---349

Introduction thesia, using chronic analgesic drugs, having neurological

deficits in the lower extremities and illnesses that interfered
Pain control is one of the major concerns after hip surg- with communication skills such as mechanical ventilation
eries. Patients often experience moderate to severe pain requirement and patients having insufficient data were
after these procedures, and pain control has a significant excluded from the study. Patients with unsuccessful blocks
impact on functional recovery after joint arthroplasty.1,2 were also excluded from the final evaluation. A flow chart
Effective pain control is reported to increase patient demonstrating patient selection is presented in Figure 1.
satisfaction.3 Poor pain control is associated with the pro- Although we have a standard protocol for postoperative
longed rehabilitation time.3 Delayed recovery increases the analgesia, there was no standard preoperative analgesia
risk of postoperative complications and postoperative pain protocol in our institution; meperidine or morphine treat-
emerges as a serious problem after the hip surgeries.3 ment was used with acetaminophen intravenously in the hip
Peripheral nerve blocks have been increasingly used fractured patients. Patients who were not treated accord-
in recent years to improve pain control and reduce ing to this standard analgesia protocol (see below) were also
complications.4,5 Both single and continuous nerve blocks excluded. Anesthesia and postoperative analgesia protocols
can be used as part of a multimodal analgesia protocol. for S-FICB and EA patients were as follows:
Multimodal approaches include the use of nonsteroidal anti-
inflammatory drugs (NSAIDs), opioids, infiltration analgesia, Anesthesia protocol
and neuraxial techniques in combination with peripheral No premedication was applied to the patients before
nerve blocks and are recommended for better pain control operation. All patients were monitored with electrocardio-
without the serious side effects of opioid and NSAIDs follow- gram (ECG), invasive blood pressure (IBP), pulse oximetry
ing surgery.4 Epidural analgesia (EA) is suitable for major (SaO2), and end-tidal carbon dioxide (EtCO2 ) in the opera-
hip surgeries but is subject to technical difficulties and has tion room. General anesthesia was induced with propofol
contraindications such as anticoagulation.6 This technique 0.5---2.0 mg.kg-1 or thiopental 3---5 mg.kg-1 . Remifentanil
is also associated with many adverse effects. 0.2---0.5 mcg.kg-1 and rocuronium 0.5---0.6 mg.kg-1 were
Fascia iliaca compartment block (FICB) is an alterna- administered to facilitate tracheal intubation. Anesthesia
tive to neuraxial blocks and provides adequate unilateral was maintained with O2 /N2 O 50/50 fresh gas, and 0.5---2%
analgesia with fewer adverse effects than EA.2 Hebbard sevoflurane. Neuromuscular blockade was antagonized with
et al. described and Desmet et al. modified a new approach, 0.05 mg.kg-1 neostigmine and 0,015 mg.kg-1 atropine before
suprainguinal fascia iliaca compartment block (S-FICB), extubation.
which enables more effective cranial spread of the local
anesthetics than conventional FICB.7,8 FICB has been asso-
ciated with reductions in both opiate consumption and pain Postoperative analgesia protocol for S-FICB and EA after
scores in many studies, but a recent systematic review has hip surgeries
reported that further research is needed to investigate the FICB and epidural catheter techniques which applied for
technique and administered volume for FICB.3 To date, there postoperative analgesia were explained to the patients
has been few studies reported focusing on the effectiveness before surgery. The analgesic technique was preferred by
of the S-FCIB after hip surgeries.3 the patients if there was no any contraindication. Epidu-
In this retrospective cohort study, we compared the ral catheter was the first choice in suitable patients who
effectiveness of a single injection ultrasound-guided S- were undecided about the analgesic method. S-FICB was
FICB with continuous lumbar EA in patients undergoing the first choice for patients who could not inserted an
hip surgery. We hypothesized that the US-guided S-FICB epidural catheter due to the use of anticoagulants or tech-
would provide postoperative analgesia comparable to the nical difficulties. All patients received intravenous (IV)
EA. The primary outcomes were opioid consumption, static, acetaminophen 20 mg.kg-1 during the operation. Morphine
and dynamic visual analog scale (VAS) pain scores. Sec- or meperidine was administered as needed during extuba-
ondary outcomes included success rate of two techniques tion and opioid doses were recorded. Our pain management
and occurrence of side effects. team has visited patients at 6-h intervals. The target VAS-R
score was ≤ 3. Static VAS (VAS-R) was evaluated during rest-
ing and dynamic VAS (VAS-M) was evaluated with active leg
Methods lifting to 15 degrees. The orthopedic ward nurse called our
team if the patients complained of pain between scheduled
Study design visits.
EA: The epidural catheter was placed using the classi-
This retrospective cohort study included 150 patients and cal landmark technique during surgery after intubation and
was approved by the local ethics committee (Mersin Uni- injection of 10 mL of 0.25% bupivacaine. Imaging techniques
versity Clinical Research Ethics Committee, No : 2018-81). (fluoroscopy or US-guidance) were not used routinely. If
Data were collected from the medical records of patients VAS score was > 3, additional local anesthetic was admin-
who underwent hip surgery between August 1, 2017 and istered and switched to infusion method (5---10 mL.h-1 ) after
January 30, 2018. Inclusion criteria were patients undergo- catheter location was verified. Patient-controlled analgesia
ing primary hip arthroplasty under general anesthesia either (PCA) was initiated if there was a problem with the catheter
with EA (n = 78) or with S-FICB (n = 72) performed by the site and set to 0.5 mg morphine IV on demand with 15-minute
same anesthesiologist (MA) for the postoperative analgesia. lockout interval. Additional morphine or acetaminophen was
Patients receiving spinal or combined spinal-epidural anes- administered as needed during the entire postoperative

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Figure 1 Flow diagram of the patient selection for the comparison between the two groups.

follow-up period. Patients were mobilized on the first post- to morphine equivalent (7.5 mg IV meperidine = 1 mg IV
operative day. If the patients complained of weakness, the morphine). Vital signs were tracked by using patient follow
epidural washout method with saline was used and the infu- chart which recorded hourly by nurse in the ICU or ward.
sion rate was decreased. Hypotension (systolic blood pressure < 90), hypoxia (SpO2 <
S-FICB: Single-shot US guided S-FICB was administered 90%), and nausea-vomiting complaints which required any
after intubation and before surgery was initiated. An injec- treatment were reported. Walking ability was evaluated to
tion 0.40---0.60 mL.kg-1 of 0.25% bupivacaine was given using test quadriceps weakness on the second day, in patients with
the US-guided longitudinal suprainguinal approach described complaints associated with walking were evaluated with
by Desmet et al.8 Additional volume was administered if suf- manual muscle test. Postoperative length of hospital stay
ficient local anesthetic distribution was not observed. If VAS and adverse events attributed to opioid use were compared.
score was > 3 after extubation, it was considered a failed In addition, medical history of antiplatelet or anticoagulant
block. Acetaminophen was administered at 20 mg.kg-1 every drug use and the number of patients for whom the analgesic
6 hours, except for patients without pain during the first intervention failed were also recorded.
postoperative 48 hours. In addition, if VAS score was > 3 at
any time postoperatively, PCA was set to 0.5 mg morphine on
demand with 15-minute lockout interval or equivalent dose
Statistical analysis
of meperidine.
All patients were monitorized at least 30 minutes in the
Sample size was calculated with using data for EA in a pre-
PACU after surgery. Therefore, first assessment was carried
vious study and was found 67 patients per group needed
out and pain measurement, morphine consumption, and side
to detect 30% change of morphine consumption between EA
effects at ‘‘zero hour’’ were also recorded in the PACU.
and S-FICB patients with a power of 80% and a risk of 0.05 for
Patients who had pain were given 0.5 mg intravenous mor-
type 1 error.9 Shapiro-Wilk test was used for normality and
phine with the target VAS: Three in this period. Pain levels
comparisons were performed using the Mann-Whitney U test
and morphin consumptions were evaluated by an anesthetist
between the two groups because of non-normally distributed
(SA) in the postoperative pain management team at the
data. Fisher’s exact test was used to compare for categorical
intensive care unit (ICU) and ward. Standard VAS (0---10 cm)
variables. Continous variables were expressed as median and
was used for pain assessment. VAS scores were recorded
interquartiles, categorical variables were expressed as fre-
while at rest (VAS-R) and during active movement (VAS-
quency and percentage. Statistical analysis was performed
M) at postoperative 6th , 12th , 24th , and 48th hours. Daily
with www.e-picos.com New York Software and Medcalc Sta-
morphine consumption at postoperative 6th , 12th , 24th , and
tistical Package program. A p-value < 0.05 was determined
48th hours were also recorded. Meperidine was converted
statistically significant.

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Table 1 Patients demographics and operation characteristics.

S-FICB (n = 72) EA (n = 78) p

Age (years) 70.50 [65.00---77.75] 69.00 [65.00---78.25] 0.83
Gender
Male 32 (44%) 42 (53%)
Female 40 (56%) 36 (47%) 0.25
Comorbid diseases
Hypertension 31 (43.0%) 31 (39.7%)
Diabetes Mellitus 26 (36.1%) 22 (28.2%)
Coronary artery disease 16 (22.2%) 12 (15.3%)
Cerebrovascular disease 5 (6.9%) 4 (5.1%) 0.71
Renal failure 6 (8.3%) 5 (6.4%)
Electrolyte imbalance 1 (1.3%) 1 (1.2%)
COPD 2 (2.6%) 5 (6.4%)
Hypo/hyperthyroidism 2 (2.6%) 3 (3.8%)
ASA
I 1 (1.3%) 6 (7.6%)
II 29 (40.2%) 34 (43.5%) 0.26
III 35 (48.6%) 32 (41.0%)
IV 7 (9.7%) 6 (7.6%)
Preoperative analgesic treatment
No need any treatment 31 (43%) 40 (51.2%)
Acetaminophen 11 (15.2%) 7 (8.9%)
Meperidine infusion 10 mg.h-1 20 (27.7%) 21 (26.9%) 0.72
Morphine infusion 1 mg.h-1 10 (13.8%) 10 (12.8%)
1-year mortality 8/72 (11.1%) 11/78 (14.1%) 0.63
Waiting time for urgent surgery (days) 0 0---1 0 0---1 0.38
Surgery duration (h) 120 [106---130] 120 [110---135] 0.58
Length of stay (days) 3 [3---4] 3 [3---4] 0.94
Acetaminophen dose (vial) 3.00 [2.00---3.00] 0.00 [0.00---0.25] 0.00 *
Used erythrocyte pack 2 [2---3] 2 [2---3] 0.73
Postoperative hematocrit level (mg.dL-1 ) 9.50 [9.12---9.90] 9.40 [9.20---9.60] 0.36
Surgery
Total hip replacement 21 (29.2%) 29 (37.2%)
Partial hip replacement 30 (41.6%) 23 (29.5%) 0.28
Internal nail 12 (16.7%) 19 (24.3%)
Plate-screw 9 (12.5%) 7 (9.0%)

S-FICB, suprainguinal fascia iliaca compartment block; EA, epidural analgesia; ASA, American Society of Anesthesiologists; COPD, Chronic
Obstructive Pulmonary Disease.
Values were presented as median [Q1---Q3] or %.

Results groups according to total opioid consumption (0 [0---0] vs. 0

[0---0] respectively, p > 0.05) (Table 2). Static and dynamic
We retrospectively analyzed data from a total of 150 VAS scores were found similar in the first 18 hours, but VAS
patients. For comparison, the patients were divided into scores were significantly lower at 24th and 48th hours in the
S-FICB group (n = 72) and EA group (n = 78) according to EA group (p < 0.05) (Tables 3 and 4).
the postoperative analgesia they received. The patients’ While US-guided S-FICB was successfully performed in
demographic and surgical characteristics are summarized in 72 (98%) patients, the number of successful interventions
Table 1. There were no statistically significant differences was found 78 (95%) in the EA group. In terms of the num-
between the two groups with respect to age, gender, comor- ber of patients treated without opioid, more patients have
bid dissease, American Society of Anesthesiologists (ASA) received opioid therapy (51 vs. 72 patients respectively,
physical status, wait time for surgery, transfused red blood p < 0.01). The incidence of hypotension was significantly
cell, postoperative hemoglobin level or operative time (p > higher in the EA group (9 vs. 21 respectively, p < 0.05). The
0.05 for all) (Table 1). The use of acetaminophen was found incidence of nausea-vomiting, hypoxia, and muscle weak-
higher in the S-FICB group than the EA (3.00 [2.00---3.00] vs ness were found similar between two groups (Table 5).
0.00 [0.00---0.25] respectively, p < 0.05). S-FICB was successfully performed without any complication
Opioid consumption was lower at emergence in the EA in six patients who received antiplatelet or anticoagulant
group (0 [0---1] vs. 0 [0---0] mg respectively, p < 0.05). drugs.
There was no statistically significant difference between two

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Table 2 Comparison of morphine consumption between the two groups.

Group S-FICB Group EA

Time Med [Q1-Q3] Min-max Med [Q1-Q3] Min-max p

th
0 h 0[0-1] 0-2 0[0-0] 0-3 p < 0.05*
6th h 0 [0-0] 0-3 0 [0-0] 0-6 p > 0.05
12th h 0 [0-0] 0-4 0 [0-0] 0-4 p > 0.05
18th h 0 [0-0] 0-3 0 [0-0] 0-3 p > 0.05
24th h 0 [0-0] 0-3 0 [0-0] 0-3 p > 0.05
48th h 0 [0-0] 0-2 0 [0-0] 0-3 p > 0.05
Total 0 [0-0] 0-12 0 [0-0] 0-16 p > 0.05

S-FICB, suprainguinal fascia iliaca compartment block; EA, epidural analgesia.

* Statistically significant value.

Table 3 Comparison of Static VAS scores between the two groups.

Group S-FICB Group EA

Time Med [Q1-Q3] Min-max Med [Q1-Q3] Min-max p

0th h 1 [0-2] 0-3 0 [0-2] 0-4 > 0.05
6th h 1 [0-2] 0-3 0 [0-2] 0-4 > 0.05
12th h 1 [0-2] 0-4 1 [0-2] 0-3 > 0.05
18th h 1 [0-2] 0-3 0 [0-2] 0-3 > 0.05
24th h 0 [0-2] 0-3 0 [0-1] 0-3 < 0.05*
48th h 0 [0-2] 0-3 0 [0-0] 0-2 < 0.05*

S-FICB, suprainguinal fascia iliaca compartment block; EA, epidural analgesia.

* Statistically significant value.

Table 4 Comparison of Dynamic VAS scores between the two groups.

Group S-FICB Group EA

Time Med [Q1-Q3] Min-Max Med [Q1-Q3] Min-Max p

th
0 h 3 [3-4] 0-6 3 [3-4] 0-6 > 0.05
6th h 3 [2-4] 0-6 3 [2-4] 0-6 > 0.05
12th h 3 [3-4] 0-7 3 [2-4] 0-5 > 0.05
18th h 3 [2-4] 0-5 3 [2-4] 0-5 > 0.05
24th h 3 [2-4] 0-5 2 [2-3] 0-5 < 0.05*
48th h 3 [2-4] 0-5 2 [0-3] 0-4 < 0.05*

S-FICB, suprainguinal fascia iliaca compartment block; EA, epidural analgesia.

* Statistically significant value.

Table 5 Comparison to success rate and side effects in the patient groups.

S-FICB (n = 72) EA (n = 78) p

Successful block 72/73 (98%) 78/82 (95%) 0.21
Accidental catheter removal N/A 2 ---
No. of patients without morphine administered 51/72 (70%) 72/82 (92%) < 0.01*
Nausea---vomiting 6 (8%) 11 (14%) 0.25
Hypotension 9 21 0.04*
Hypoxia 4 6 0.60
Muscle weakness 0 0 1

S-FICB, suprainguinal fascia iliaca compartment block; EA, epidural analgesia.

* Statistically significant value.

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 Brazilian Journal of Anesthesiology 2022;72(3):342---349

Discussion plasty. It is frequently implemented by catheter after these

surgeries and optimal pain control is sustained even into
We observed from our study that US-guided S-FICB pro- the late postoperative period. It has been suggested that
vided analgesia equal to the EA technique after hip surgeries although EA provides better analgesia during movement than
in the early postoperative period, but that the EA pro- IV opioid administration, the lower pain score advantage of
vided significantly better analgesia after 18 hours. Morphine EA at rest is limited to the first 4---6 hours.18 The use of opi-
consumption was statistically equal at all measured time oid added local anesthetics may provide better analgesia
points except emergence, as was total morphine consump- during neuraxial interventions but it may cause also more
tion. Hypotension was observed more frequent in patients frequent side effects. EA may also have better analgesic
receiving EA. S-FICB was successfully administered with no effect than nerve blocks during exercise.19 However, periph-
complications in patients under antiplatelet or anticoagu- eral nerve blocks may provide equal postoperative analgesia
lant therapy. to the EA with fewer complications after lower extremity
A meta-analysis suggested that the analgesic efficacy surgeries.18,20 A study comparing the analgesic efficacy of
of single-shot FICB lasts up to 24 hours.9 Temelkovska these three methods showed that continuous 3-in-1 block
et al. reported that the analgesic effect of single-shot could have a similar effect to EA and IV opioid administration
FICB begins to decrease after 12 hours.10 There are few with fewer side effects.21
studies comparing S-FICB with other analgesia methods in US guidance is used when administering neuraxial or
the literature. Our results indicated that single-shot S-FICB peripheral nerve blocks and increases rates of success. In the
can provide adequate early postoperative analgesia after present study, the success rate for S-FICB was 98%. A review
hip surgery. However, we found that it has limited dura- reported 99% success of epidural catheter placement using
tion of action compared to the EA technique, which can the landmark technique, but adequate anesthesia/analgesia
provide long-term pain control with infusion or repeated may be achieved at a rate of only 76% at the lumbar epidu-
doses. Although morphine administered before extubation ral level.22 We determined a 93.8% success rate of EA in our
may have resulted in higher morphine consumption in the study. However, factors such as misplacement or migration
S-FICB group during emergence, total morphine consump- of the catheter and individual variations in the structure of
tion was similar between the two groups in our study. the epidural area reduce the effectiveness of the EA in pain
Regular acetaminophen reduces VAS pain score, opioid con- control.23 Accidental catheter removal is one of the prob-
sumption, and opioid-related adverse effects.11 Average lems associated with catheter techniques. This occurred
acetaminophen use was found to be higher in the S-FICB in two patients in the EA group in our study. While fewer
group than EA. The administration of acetaminophen may patients needed opioid treatment in the EA group, the mean
have contributed to the effectiveness of the analgesia in VAS scores and total morphine consumption were similar in
our S-FICB group. the two groups. This suggests that patients whose catheters
Conventional FICB may offer better analgesia and reduce were misplaced or accidentally removed may have increased
morphine consumption compared to a control group after the overall morphine consumption of the EA group in our
hip surgeries.12 There are only two conflicting studies in study.
the literature comparing conventional FICB and EA. Rash- Although it provides better pain control than many other
wan et al. found that patients in the EA group had lower pain techniques, continuous EA causes certain adverse effects
score and tramadol consumption than patients who received such as urinary retention, hypotension, and bilateral mus-
continuous FICB after femur neck fracture surgery.13 How- cle weakness.2,18 Hypotension is a common side effect of EA
ever, Nooh et al. reported that both techniques had similar due to vascular dilation caused by sympathetic denervation.
analgesic effect after hip and knee surgeries.14 Conventional Hypotension occurs more frequently with the epidural tech-
FICB was administered using an unguided technique in both nique than systemic analgesia and nerve blocks. Consistent
studies. Although FICB can be performed blind, US-guidance with the literature, in our study hypotension was significan-
increases block success by ensuring injection in the cor- tly more common in the EA group than the S-FICB group.
rect space and allows monitoring for adequate distribution, All other adverse effects occurred at the same frequency in
resulting in better analgesia than the blind technique.15 In both groups.
addition, the recommended volume is 30---40 mL for FICB, Muscle weakness is attributed to both FICB and the EA.
but 30 mL of local anesthetic was used in these studies. Behrends et al. suggested that preoperative FICB did not
In the present study, the mean volume was 30.7 mL, but improve pain control after hip arthroscopy but may cause
local anesthetic was administered with US-guidance and quadriceps weakness.24 However, the results of a meta-
no patient received a volume less than 0.4 mL.kg-1 . Fur- analysis are inconsistent with this finding.3 It was suggested
thermore, we performed FICB via proximal suprainguinal that the programmed intermittent epidural bolus technique
approach, which provides better analgesia than the conven- may provide greater dermatomal spread and lower pain
tional method.16 scores compared to continuous administration.25 Moreover,
There is no gold standard anesthetic method for hip adding continuous infusion to epidural PCA may increase
surgery. In terms of mortality, the advantage of neuroaxial analgesic quality but also increase the incidence of mus-
techniques over general anesthesia has not been proven.17 If cle weakness.26 Recent studies showed that a programmed
the patient prefers, neuroaxial anesthesia is the first choice intermittent bolus regimen provides better pain control and
in our clinic. However, general anesthesia is preferred in less motor blockade than continuous infusion via both EA
anticoagulant/antiplatelet drug use, serious heart valve dis- and lumbar plexus catheter.25 But, this undesirable event
eases or operations that are known to last long. EA is the one could be ceased by repositioning the catheter or reducing
of the best methods of pain management after hip arthro- anesthetic concentration by suspending infusion and using

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 M. Azizoğlu and Ş. Rumeli

washout technique.27,28 The intermittent bolus method was rehabilitation after unilateral total-hip arthroplasty. Reg Anesth
used in our patients according to our analgesia protocol and Pain Med. 2005;30:452---7.
no patient suffered muscle weakness in either group on the 3. Gao Y, Tan H, Sun R, et al. Fascia iliaca compartment
first postoperative day. block reduces pain and opioid consumption after total hip
arthroplasty: A systematic review and meta-analysis. IJS.
There is no consensus regarding the timing of surgery
2019;65:70---9.
for hip fracture patients who are being treated with 4. Joshi G, Gandhi K, Shah N, et al. Peripheral nerve blocks in the
anticoagulant drugs. In orthopedic surgery guidelines, the management of postoperative pain: challenges and opportuni-
moderate recommendation is that fracture patients undergo ties. J Clin Anesth. 2016;35:524---9.
surgery within the first 48 hours to reduce mortality.29 How- 5. Chelly JE, Ghisi D, Fanelli A. Continuous peripheral nerve
ever, the epidural technique is not suitable for patients blocks in acute pain management. Br J Anaesth. 2010;105 Suppl
using anticoagulant therapy without delay. Neuraxial block 1:i86---96.
is contraindicated in patients receiving antiplatelet or 6. Horlocker TT, Vandermeuelen E, Kopp SL, et al. Regional
anticoagulant, whereas peripheral nerve block may be Anesthesia in the Patient Receiving Antithrombotic or Throm-
administered in compressible regions.6 The injection site for bolytic Therapy American Society of Regional Anesthesia and
Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg
S-FICB is distant from major nerves and blood vessels; there-
Anesth Pain Med. 2018;43:263---309.
fore, US-guided S-FICB can be considered safe in this patient 7. Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal
group. Almeida et al. showed that FICB under sedation was fascia iliaca block: a cadaveric evaluation of a novel approach.
sufficient for surgery in hip fracture patients receiving anti- Anaesthesia. 2011;66:300---5.
coagulant drugs.30 We believe that US-guided S-FICB may be 8. Desmet M, Vermeylen K, Van Herreweghe I, et al. A Longitu-
used in patients using antiplatelet or anticoagulant drugs dinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces
and could offer a substantial advantage for both anesthe- Morphine Consumption After Total Hip Arthroplasty. Reg Anesth
sia and analgesia for hip fracture surgery. These patients Pain Med. 2017;42:327---33.
should be monitored more closely due to the development 9. Milligan KR, Convery PN, Weir P, et al. The Efficacy and Safety of
of hematoma in addition to the described complications. Epidural Infusions of Levobupivacaine With and Without Cloni-
dine for Postoperative Pain Relief in Patients Undergoing Total
We conducted a retrospective study, and it was major lim-
Hip Replacement. Anesth Analg. 2000;91:393---7.
itation of our study. Data was collected from well-structured 10. Stevanovska MT, Durnev V, Srceva MJ, et al. Continuous femoral
follow-up records kept by the postoperative pain manage- nerve block versus fascia iliaca compartment block as postop-
ment team. Nevertheless, we could report only clinically erative analgesia in patients with hip fracture. Pril (Makedon
observed side effects. Secondly, urinary retention could not Akad Nauk Umet Odd Med Nauki). 2014;35:85---93.
be evaluated because urinary catheter was inserted as stan- 11. Takeda Y, Fukunishi S, Nishio S, et al. Evaluating the Effect of
dard during the follow-up period. Additionally, there was no Intravenous Acetaminophen in Multimodal Analgesia After Total
standard preoperative analgesia management for hip frac- Hip Arthroplasty: A Randomized Controlled Trial. J Arthroplasty.
ture patients. Finally, VAS scores and opioid consumption 2019;34:1155---61.
amounts were recorded only once during the emergence 12. Steenberg J, Møller AM. Systematic review of the effects of
fascia iliaca compartment block on hip fracture patients before
period.
operation. Br J Anaesth. 2018;120:1368---80.
13. Rashwan D. Levobupivacaine patient controlled analgesia:
Conclusion Epidural versus blind fascia iliaca compartment analgesia --- A
comparative study. EgJA. 2013;29:155---9.
14. Nooh NGE, Hamed AMS, Moharam AA, et al. A comparative
In conclusion, single-shot S-FICB may provide similar post- study on combined general anesthesia with either continuous
operative pain control as compared to EA in the first 18 fascia iliaca block or epidural anesthesia in patients undergo-
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Conflicts of interest 95---100.
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