Ultrasound-guided suprainguinal fascia iliaca block versus lumbar erector spinae block for oncologic thigh surgery.

INTRODUCTION

Effective pain management is essential for patients undergoing limb-sparing procedures as well as amputation in patients with cancer.

OBJECTIVES

This study evaluated the analgesic effects of the ultrasound-guided suprainguinal fascia iliaca block (SIFIB) and the ultrasound-guided lumbar erector spinae plane block (L-ESPB) in patients who underwent oncologic thigh surgery.

METHODS

Seventy-five patients with thigh cancers and ASA class II, III were randomized into 3 groups: SIFIB, ESPB, and control groups. The primary outcome was opioid consumption within 24 hours. The secondary outcomes were intraoperative fentanyl consumption, time to first rescue analgesic request, pain scores, and patient satisfaction.

RESULTS

In our study, only 6 patients (24%) in the SIFIB group and 3 patients (12%) in the ESPB group required a single 3 mg dose of morphine, compared with 20 patients (80%) in the control group ( < 0.001). There was no significant difference between the SIFIB and ESPB groups in rescue morphine use ( = 0.463). Total fentanyl consumption was significantly lower in both the SIFIB and ESPB groups compared with the control group ( < 0.001), with no significant difference between the 2 blocks ( = 0.953). Time to first rescue analgesia was significantly longer in the SIFIB and ESPB groups compared with the control group ( < 0.001) and was similar between the block groups ( = 1.000). Pain scores were significantly lower and patient satisfaction significantly higher in both block groups compared with the control group ( = 0.042), with reduced postoperative nausea and vomiting.

CONCLUSION

In patients undergoing oncologic thigh surgery, SIFIB and L-ESPB are comparable, effective, and safe regional analgesic alternatives.