Ultrasound-Guided Suprainguinal Fascia Iliaca Block as Part of Anesthesia Management for Lower Extremity Surgeries: A Single-Center Retrospective Cohort Feasibility Study

Fascial plane blocks as the main anesthetic method: A narrative review

This narrative review evaluates the efficacy of fascial plane blocks (FPB) as sole anesthetic method for surgery. Particularly in selected high-risk patients, fascial plane blocks may be a more useful and convenient option than general anesthesia or neuraxial anesthesia. In recent years, with the use of ultrasound, newly defined FPBs have emerged and these techniques have become popular. There are case reports in the literature reporting the use of these blocks for anesthesia, but clinical studies are limited and clinicians may be undecided about which block or combination to apply in which case. In this narrative review, which is the first in this field in the literature, we aimed to discuss the use of FPBs and which combinations can be used in which incisions and which surgeries.

Comparison of the effects of two regional anesthetic techniques on pain during high risk hip fracture surgery

OBJECTIVES

In this study, we evaluated perioperative pain management using the Analgesia Nociception Index (ANI) monitoring in high-risk ASA III-IV patients scheduled for hip surgery. Specifically, we examined the lumbar plexus (LP), sacral plexus (SP), and supra-inguinal fascia iliaca compartment blocks (SIFIB), as well as combinations of SP blocks.

METHODS

In this prospective observational study, we included 74 patients who were assigned to one of two groups: Group L, which received LP and SP blocks, and Group F, which received SIFIB and SP blocks. Surgery was performed after confirming the sensory block with the pinprick test and applying the sedation protocol. Sedation levels were evaluated using the BIS monitor whereas analgesic requirements were assessed using the ANI monitor. Demographic data, including age, sex, ASA score, SpO2, heart rate (HR), mean arterial pressure (MAP), duration of sensorimotor block, type and duration of surgery, time to first analgesic use, and total analgesic consumption, were recorded. Visual analog scale (VAS) scores at 0, 6, 12, and 24 h additional analgesic requirements, and satisfaction ratings from patients and surgeons were also evaluated.

RESULTS

Compared to Group F, Group L presented significantly greater ANI values at 30, 60, 90 min intraoperatively, as well as at 6 and 12 h postoperatively. The VAS scores were consistently higher in Group F than in Group L at all measurement times.

CONCLUSION

Group L provided better analgesia, required fewer sedatives during surgery, and had greater satisfaction among patients and surgeons. A negative correlation was found between the VAS score and ANI for assessing patient pain.

Continuous Suprainguinal Fascia Iliaca Block for Postoperative Analgesia Management After Hip and Knee Arthroplasty Surgeries: A Report of Two Cases

Knee and hip arthroplasty are common orthopedic procedures that are frequently associated with moderate to severe postoperative pain. Regional anesthesia techniques play a crucial role in multimodal analgesia strategies for managing postoperative pain. The suprainguinal fascia iliaca (SIFI) block is an effective regional anesthesia technique frequently used for postoperative analgesia in lower extremity surgeries, including knee and hip arthroplasty. These techniques can be safely applied either as a single-shot injection or via continuous catheter insertion. In this case report, we describe our experience with the use of continuous SIFI block for postoperative analgesia in knee and hip arthroplasty.

The Gluteus Deep Investing Fascia Compartment Block: A Novel Technique for Posterior Femoral Cutaneous Nerve Block

Purpose

The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the "Gluteus-Deep Investing Fascia compartment Block (GDIF block)" for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the 'Gluteus Deep Investing Fascia Compartment'. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named "CLEFT Block." This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique.

Patients and Methods

Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine.

Results

The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia.

Conclusion

The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.

Combined Supra-Inguinal Fascia Iliaca, Sciatic Nerve, and Posterior Femoral Cutaneous Nerve Blocks in Austere Settings for Hemodynamically Unstable Patients with Vascular Injuries from Weapon Wounds: A Case Series

Purpose

The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique-sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks -in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.

Patients and Methods

Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.

Results

The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.

Conclusion

The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.