Infrainguinal vs. Suprainguinal Approach of Ultrasound-Guided Fascia Iliaca Block for Analgesia after Intertrochanteric Femur Surgery: A Randomized Controlled Trial

Abstract

Background: Intertrochanteric femur fractures are prevalent orthopedic injury among the the geriatric population and demand adequate pain relief after surgery to improve recovery. While opioids are commonly used for analgesia, concerns about their side effects have led to increased interest in regional anesthesia techniques. The supra-inguinal (S-FICB) and infra-inguinal (I-FICB) fascia iliaca compartment blocks are two such approaches, but comparative studies on intertrochanteric fracture surgery are few. The present study was conducted to compare the efficacy and safety of the S-FICB approach with the I-FICB approach for postoperative pain management.
Methods: This single-center, prospective, randomized, double-blind clinical trial included 80 patients aged 55–75 years who underwent intertrochanteric femur fracture surgery. The participants were randomly divided to receive either S-FICB or I-FICB under real-time ultrasound guidance after spinal anesthesia. The main outcome measure was the pain index at rest and movement, based on the Numeric Rating Scale (NRS) score, which was compared at multiple intervals up to 24 hours. Secondary outcome measures included total morphine consumption over the 24-hour postoperative period, time to first request for morphine, and the occurrence of adverse effects.
Results: At 1, 4, 8, and 16 hours after surgery, patients in the S-FICB group experienced significantly lower pain scores, both at rest and during movement relative to the I-FICB group (P < 0.05), but not at 24 hours. Although the mean consumption of morphine was slightly lower in the S-FICB group (4.5 ± 1.2 mg) compared to the I-FICB group (5.2 ± 1.3 mg), the difference was not significant (P value > 0.05). Although the S-FICB group demonstrated a prolonged interval to initial morphine administration compared to the I-FICB group, this difference was not statistically significant (P value > 0.05). Patient satisfaction scores were significantly superior in the S-FICB group (P value < 0.05), while adverse events were similar between the groups.
Conclusion: In the early postoperative period, the S-FICB approach had better postoperative pain relief and greater patient satisfaction than I-FICB. However, there were no significant differences between groups in opioid use or the incidence of adverse effects.