Block Pain: Study Unleashes Power of Suprainguinal Fascia Iliaca Compartment Block for Proximal Femur Fracture Relief

Analgesic management for pain following proximal femur fractures is critical to enhancing patient recovery. In a recent controlled study involving 60 adult trauma patients scheduled for surgical fixation of proximal femur fractures, the effectiveness of three analgesic techniques was compared: the continuous fascia iliaca plane block using a suprainguinal approach (SFICB), the continuous fascia iliaca plane block using an infrainguinal approach (IFICB), and a femoral nerve block (FNB). Participants were randomized into one of the three groups, receiving ultrasound-guided blocks with 0.2% ropivacaine for postoperative analgesia, followed by a continuous infusion at 10 mL/h for the first 24 hours.

Study Objectives

The primary aim was to assess the number of rescue analgesic (RA) doses required within the first 24 hours post-surgery to maintain a visual analogue scale (VAS) pain score below 4. Secondary objectives included total morphine consumption, duration of analgesia, pain scores over time, quality of pain relief, and the assessment of any adverse effects.

Results Overview

Results showed that patients in the SFICB group had a significantly lower need for RA doses: only 15% required additional morphine, compared to 40% in the IFICB group and 50% in the FNB group. Furthermore, median morphine consumption was notably less in the SFICB group (3 mg) than the IFICB (6.5 mg) and FNB (9.0 mg) groups, indicating better analgesic efficacy. SFICB patients reported lower median VAS scores and higher quality of pain relief, with a significant proportion noting excellent pain relief compared to those in the other two groups.

Methodological Considerations

Methodologically, patients were carefully selected based on specific criteria to ensure reliability. Those with any prior analgesic therapies, infections, pregnancy, or other relevant comorbidities were excluded. Each block's feasibility and performance time were recorded along with patient-reported side effects. Patients in all groups underwent monitoring for hemodynamic stability during the procedure.

Efficacy of SFICB

Results demonstrated the superior analgesic efficacy of the SFICB approach due to its more extensive local anesthetic spread, successfully covering the femoral, lateral femoral cutaneous, and obturator nerves. While both the FNB and IFICB techniques were effective, they lagged behind SFICB in terms of overall effectiveness and patient satisfaction.

Clinical Implications

The findings emphasize the clear advantage of using a continuous suprainguinal fascia iliaca compartment block as a preferred technique for postoperative pain management in patients with proximal femur fractures. The implications suggest that implementing SFICB can lead to reduced opioid consumption and better pain management, providing a more effective strategy for enhancing recovery in surgical patients. This study supports the notion that optimized regional anesthesia techniques can play a pivotal role in improving postoperative care outcomes and patient satisfaction. Further investigations could expand to assess long-term effects and explore the potential for additional adjunct therapies to augment analgesic strategies.

Key Points

- A controlled study with 60 adult trauma patients evaluated three analgesic techniques for postoperative pain management following proximal femur fractures: continuous fascia iliaca plane block using a suprainguinal approach (SFICB), continuous fascia iliaca plane block using an infrainguinal approach (IFICB), and femoral nerve block (FNB). Each participant received ultrasound-guided blocks with 0.2% ropivacaine followed by a continuous infusion for the first 24 hours post-surgery.

- The primary objective was to analyze the number of rescue analgesic doses needed within the first 24 hours to maintain a visual analogue scale (VAS) pain score below 4. Secondary objectives assessed total morphine consumption, duration of analgesia, pain scores over time, quality of pain relief, and side effects.

- Results indicated that only 15% of patients in the SFICB group necessitated additional morphine for pain relief, significantly lower than 40% in the IFICB group and 50% in the FNB group, suggesting superior effectiveness of the SFICB technique.

- Median morphine consumption was significantly reduced for the SFICB group (3 mg), compared to the IFICB (6.5 mg) and FNB (9.0 mg) groups, demonstrating the SFICB's enhanced analgesic efficacy.

- The superior analgesic performance of SFICB is attributed to its broader local anesthetic spread, covering essential nerves including the femoral, lateral femoral cutaneous, and obturator nerves, resulting in lower median VAS scores and improved patient satisfaction in pain management.

- The findings suggest that SFICB is a preferred postoperative pain management technique for proximal femur fractures, potentially leading to reduced opioid consumption and improved patient recovery outcomes. The study indicates a need for further exploration of long-term effects and adjunct therapies to enhance analgesic strategies.

Reference –

Nidhi Bhatia et al. (2025). Continuous Peripheral Nerve Block In Patients With Proximal Femur Fracture: A Randomised Comparison Of Three Techniques. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_1095_24.