A Prospective Study to Compare Analgesia from Femoral Obturator Nerve Block with Fascia Iliaca Compartment Block for Acute Preoperative Pain in Elderly Patients with Hip Fracture

Objectives: To evaluate the efficacy of obturator nerve block combined with spinal anaesthesia for prevention of adductormuscle spasm and its associated complications during transurethral resection of bladder tumours located at its lateral and inferolateral wall.Study design: A prospective study. Setting: At AFIU Rawalpindi. Period: From January 2005 to December 2006. Material and methodFifty patients who had tumours at their lateral / inferolateral bladder wall of physical status ASA I - IV received spinal anaesthesia at 3r d or4l h lumbar space followed by obturator nerve block with a view to preventing adductor jerk during resection of tumour. Results: There wascomplete suppression of adductor jerk in 45 (90%) patients and surgery was completed smoothly. Two patients (4%) had mild adductorjerk and additional sedation was required. The block failed to work in 3 (6%) cases and required conversion to general anaesthesia. Thusthe procedure was successful in 94% (complete and partial suppression of jerk. Conclusion: We conclude that spinal anaesthesiacombined with obturator nerve block is an effective technique for preventing adductor jerk during TUR-BT, thus avoiding intra-operative andpost operative complication.

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Implementation of the Obturator Nerve Block into a Supra-Inguinal Fascia Iliaca Compartment Block Based Analgesia Protocol for Hip Arthroscopy: Retrospective Pre-Post Study

Medicina ◽

10.3390/medicina56040150 ◽

2020 ◽

Vol 56 (4) ◽

pp. 150

Author(s):

Seounghun Lee ◽

Jung-Mo Hwang ◽

Sangmin Lee ◽

Hongsik Eom ◽

Chahyun Oh ◽

...

Keyword(s):

Nerve Block ◽

Hip Arthroscopy ◽

Postoperative Nausea And Vomiting ◽

Obturator Nerve ◽

Opioid Consumption ◽

Analgesic Effects ◽

Obturator Nerve Block ◽

Analgesic Regimen ◽

Significant Difference ◽

Fascia Iliaca Compartment Block

Background and Objectives: The effect of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy is not apparent. It is also controversial whether SI-FICB can block the obturator nerve, which may affect postoperative analgesia after hip arthroscopy. We compared analgesic effects before and after the implementation of obturator nerve block into SI-FICB for hip arthroscopy. Materials and Methods: We retrospectively reviewed medical records of 90 consecutive patients who underwent hip arthroscopy from January 2017 to August 2019. Since August 2018, the analgesic protocol was changed from SI-FICB to SI-FICB with obturator nerve block. According to the analgesic regimen, patients were categorized as group N (no blockade), group F (SI-FICB only), and group FO (SI-FICB with obturator nerve block). Primary outcome was the cumulative opioid consumption at 24 hours after surgery. Additionally, cumulative opioid consumption at 6 and 12 hours after surgery, pain score, additional analgesic requests, intraoperative opioid consumption and hemodynamic stability, and postoperative nausea and vomiting were assessed. Results: Among 87 patients, there were 47 patients in group N, 21 in group F, and 19 in group FO. The cumulative opioid (fentanyl) consumption at 24 hours after surgery was significantly lower in the group FO compared with the group N (N: 678.5 (444.0–890.0) µg; FO: 482.8 (305.8–635.0) µg; p = 0.014), whereas the group F did not show a significant difference (F: 636.0 (426.8–803.0) µg). Conclusion: Our findings suggest that implementing obturator nerve block into SI-FICB can reduce postoperative opioid consumption in hip arthroscopy.

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Anatomical considerations for obturator nerve block with fascia iliaca compartment block

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102553 ◽

2021 ◽

pp. rapm-2021-102553

Author(s):

Thomas Fichtner Bendtsen ◽

Erik Morre Pedersen ◽

Bernhard Moriggl ◽

Peter Hebbard ◽

Jason Ivanusic ◽

...

Keyword(s):

Nerve Block ◽

Functional Anatomy ◽

Obturator Nerve ◽

Obturator Nerve Block ◽

The Creation ◽

Artificial Pathway ◽

Fascia Iliaca Compartment Block

This report reviews the topographical and functional anatomy relevant for assessing whether or not the obturator nerve (ON) can be anesthetized using a fascia iliaca compartment (FIC) block. The ON does not cross the FIC. This means that the ON would only be blocked by an FIC block if the injectate spreads to the ON outside of the FIC. Such a phenomena would require the creation of one or more artificial passageways to the ON in the retro-psoas compartment or the retroperitoneal compartment by disrupting the normal anatomical integrity of the FI. Due to this requirement for an artificial pathway, an FIC block probably does not block the ON.

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