Successful Suprainguinal Fascia Illiaca block for surgical anaesthesia of hip surgery

• Main Authors: Rahim, Shahir Asraf, Ibrahim, MF, Saad, NL, Wong, SV
• Format: Conference or Workshop Item
• Language: English; English
• Published: UKM 2021
• Subjects: RD81 Anesthesiology
• Online Access: http://irep.iium.edu.my/96425/1/96425_Successful%20Suprainguinal%20Fascia%20Illiaca%20block.pdf; http://irep.iium.edu.my/96425/13/96425_%20Successful%20Suprainguinal%20Fascia%20Illiaca%20block_issue.pdf; http://irep.iium.edu.my/96425/; https://medicineandhealthukm.com/sites/medicineandhealthukm.com/files/article/2021/msa_asc_final_pdf_20084.pdf

Introduction: Suprainguinal Fascia Illiaca Block is unpopular choice for anaesthesia of hip surgery. Deep nerve block such as neuroaxial and lumbar plexus nerve block are much more common due to difficulty to attain relief of selective hip pain. However, these nerve blocks might not be feasible in patients with certain comorbidities such as spine and cardiovascular disease. The nerve block result in blockade of femoral nerve, lateral femoral cutaneous nerve and obturator nerve. Suprainguinal approach may result in a more proximal spread, hence more efficacious analgesia for hip surgery. Case description: We reported three successful cases of suprainguinal fascia iliaca nerve block use as anaesthesia technique supplemented with monitored anaesthesia care. The patients in our report had multiple comorbidities at which general anaesthesia and neuraxial nerve block might not be feasible. All patients presented with neck of femur fracture and underwent proximal femoral nail insertion. The first patient had lung adenocarcinoma with spine metastases and the second patient had severe aortic stenosis. The third case was a patient with hypertensive heart disease and obesity. We perform the surgeries using fascia illiaca block by suprainguinal approach under ultrasound guidance using 40 mls of lignocaine 0.5%. Catheter was inserted during the procedure and further 10 mls of levobupivacaine were given after 1 hour. All surgeries were supplemented with dexmedetomidine infusion and boluses of ketamine. Postoperatively, all patients were started on levobupivacaine infusion 0.1% at 10 mls/h for the analgesia. The surgeries were performed successfully with adequate sensory block around the hip region, and we recorded good postoperative pain control. The benefit of this technique extends beyond adequate pain relief but also allow minimal cardiovascular and respiratory interference. We concluded that ultrasoundguided superficial fascia iliaca nerve block is an effective anesthetic technique for patients undergoing surgery for fracture of the neck of femur.