Bang Seunguk, Chung Jihyun, Jeong Jaejung, Bak Hahyeon, Kim Dongju
aDepartment of Anesthesiology and Pain Medicine bDepartment of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul cDepartment of Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
Medicine (Baltimore). 2016 Sep;95(39):e5018. doi: 10.1097/MD.0000000000005018.
The fascia iliaca compartment block (FICB) provides an analgesic effect in patients with femur fractures. However, the postoperative pain after hip surgery is different from that after femur fracture, because of the difference in the degree and location of tissue trauma. Whether FICB provides effective postoperative analgesia in patients undergoing total hip arthroplasty is not well understood. Moreover, there is no prospective randomized study to evaluate FICB as a postoperative analgesia in hemiarthroplasty. Therefore, we performed a randomized and prospective study to determine the effect of FICB after hemiarthroplasty. The objective of this study was to compare the opioid consumption between patients who received intravenous patient-controlled analgesia (PCA) with and without FICB.
Twenty-two patients aged 70 to 90 years who underwent bipolar hemiarthroplasty for femoral neck fracture were recruited and allocated randomly into 2 groups: FICB group (n = 11) and Non-FICB group (n = 11). All patients received spinal anesthesia with 10 mg of 0.5% hyperbaric bupivacaine. After surgery, the FICB was conducted using a modified technique with 0.2% ropivacaine (40 mL) under ultrasonographic guidance, and the intravenous PCA was administered to patients in both groups in the separate block room. The PCA was set up in the only bolus mode with no continuous infusion. The visual analog scale (VAS) and the opioid consumption were noted at 4, 8, 12, 24, and 48 hours postoperatively.
The VAS was similar in both groups. The fentanyl requirement at 4, 8, and 12 hours was low in the FICB group. The total amount of fentanyl required in the first 24 hours was 246.3 μg in the FICB group and 351.4 μg in the Non-FICB group. No patient developed any residual sensory-motor deficit during the postoperative period. Patients in the Non-FICB group had nausea (n = 2), and pruritus (n = 1), and 1 patient had nausea in the FICB group during postoperative 2 days.
The FICB has a significant opioid-sparing effect in first 24 hours after hemiarthroplasty. This suggests that FICB is an effective way for multimodal analgesia in hip surgery.
髂筋膜间隙阻滞（FICB）对股骨骨折患者具有镇痛作用。然而，由于组织创伤程度和部位的差异，髋关节手术后的疼痛与股骨骨折后的疼痛有所不同。FICB对全髋关节置换术患者术后是否能提供有效的镇痛效果尚不清楚。此外，尚无前瞻性随机研究评估FICB在半髋关节置换术中作为术后镇痛的效果。因此，我们进行了一项随机前瞻性研究，以确定FICB在半髋关节置换术后的效果。本研究的目的是比较接受静脉自控镇痛（PCA）且有或无FICB的患者之间的阿片类药物消耗量。
招募22例年龄在70至90岁之间因股骨颈骨折接受双极半髋关节置换术的患者，并随机分为2组：FICB组（n = 11）和非FICB组（n = 11）。所有患者均接受10mg 0.5%重比重布比卡因的脊髓麻醉。术后，在超声引导下采用改良技术用0.2%罗哌卡因（40mL）进行FICB，并在单独的阻滞室对两组患者进行静脉PCA。PCA仅设置为单次推注模式，无持续输注。术后4、8、12、24和48小时记录视觉模拟量表（VAS）和阿片类药物消耗量。
两组的VAS相似。FICB组在术后4、8和12小时对芬太尼的需求量较低。FICB组在前24小时所需芬太尼总量为246.3μg，非FICB组为351.4μg。术后期间无患者出现任何残余感觉运动功能障碍。非FICB组有2例患者出现恶心，1例出现瘙痒，FICB组有1例患者在术后2天出现恶心。
FICB在半髋关节置换术后的前24小时具有显著的阿片类药物节省作用。这表明FICB是髋关节手术多模式镇痛的有效方法。
