A Comparative Study between Ultrasound Guided Fascia Iliaca Block and Femoral Nerve Block for Postoperative Analgesia in Total Knee Arthroplasty

Abstract Background Total knee arthroplasty (TKA) are common surgical procedures for treatment of the degenerative disorders and traumatic diseases. However, a majority of patients often experience moderate to severe postoperative pain after TKA. Postoperative pain control has a significant impact on earlier ambulation, initiation of physiotherapy, and better functional recovery. In addition, effective pain control would lower the length of hospital stay and the risk of thrombotic events which improves patients’ satisfaction. Aim of the Work The aim of this study was to assess the efficacy and safety of FICB compared with FNB in patients undergoing total knee arthroplasty. Patients and Methods 74 patients were included in the study, and were divided into two groups. In FICB group: Patients (n = 37) of this group received ultrasound guided Fascia iliaca compartment block (FICB) after spinal anesthesia using 30-40 ml of 0.25% bupivacaine. While in FNB group: Patients (n = 37) of this group received ultrasound guided femoral nerve block (FNB) after spinal anesthesia using 15-20 ml of 0.25% bupivacaine. Results The present study showed that the Fascia iliaca compartment block (FICB) was more efficient than FNB regarding first request analgesic, total pethidine consumption, time of ambulation and kinetic visual Analogue scale. But no significant difference was detected in static Visual Analogue scale and Bromage score. The FNB group had higher kinetic pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively and needed more time to start to ambulate in comparison to patients of FICB group. But the FNB group have almost same values regarding pain measured by static visual analogue scale. And also, FNB group had close values regarding Bromage score in comparison to FICB group. Conclusion Fascia iliaca compartment block is more effective than FNB, for pain relief during the early post- operative period after total knee arthroplasty. Meanwhile, it can reduce the cumulative meperidine consumption.