Ultrasound-Guided Suprainguinal Versus Infrainguinal Fascia Iliaca Compartment Block for Postoperative Analgesia After Total Knee Replacement: A Prospective Randomized Trial.

BACKGROUND

Fascia iliaca compartment block (FICB) can be achieved using suprainguinal (SFICB) or infrainguinal (IFICB) approaches. This study compares postoperative analgesia of SFICB and IFICB after total knee replacement (TKR).

METHODS

This prospective, randomized, single-blind study was conducted on 60 adult patients undergoing unilateral TKR under spinal anesthesia. Patients were randomly allocated into two groups: Group S received SFICB with 30 mL of 0.25% levobupivacaine with 2 mL (8 mg) dexamethasone, while Group I received IFICB with the same drugs after surgery. The primary outcome variable was 24-hour cumulative tramadol consumption. Secondary outcome variables included pain intensity, complications, hemodynamic variations, and time to first rescue analgesic request.

RESULTS

Tramadol consumption was significantly lower with SFICB (86.67±34.57 versus 34.57±33.95 mg, p=0.006). Pain intensity was lower with SFICB after six hours of surgery. Time to first analgesic request was also longer with SFICB (12.83±3.80 versus 10.12±2.98 hours, p=0.003). Time taken for administering the blocks (16.20±2.66 versus 17.17±3.13 minutes), complications, and hemodynamic variations were statistically similar between the groups.

CONCLUSION

SFICB provides superior postoperative analgesia compared to IFICB in patients undergoing TKR, with reduced opioid requirement and prolonged analgesia duration.