Comparison of Fasia Iliac Compartment Block and 4in1 Block

Comparison of Perioperative Analgesic Effectiveness of Patients Who Had Fasia Iliac Compartment Block and 4in1 Block Applied in Total Knee Prosthesis Surgery

Patients who will undergo elective total knee arthroplasty surgery under spinal anesthesia will be included in the study according to the postoperative analgesia method applied: Group Control, Group FICB and Group 4in1. Peripheral nerve block will be performed with 30 ml %0.25 bupivacaine for Group FICB and Group 4 in 1 patients. Peripheral nerve block will not be performed on Group Control patients. Patient-controlled analgesia will be given to all three groups in the postoperative period. PCA is a pain palliation method routinely used in all patients postoperatively. NRS score, PCA tramadol consumption, PCA demand, need for additional analgesia, patient satisfaction, nausea and vomiting will be monitored 24 hours postoperatively. The aim of this study is to compare the perioperative analgesic effectiveness of patients who underwent fascia iliaca compartment block and 4 in 1 block in total knee arthroplasty surgery, with each other and with the control group.

Study Overview

• Status: Completed
• Conditions: Pain, Postoperative
• Intervention / Treatment: Other: FICB; Other: 4 in 1 block; Other: Control

Detailed Description

Total knee arthroplasty is a surgical procedure performed mostly on patients with osteoarthritis who have failed traditional conservative treatment. Increasing knee osteoarthritis due to reasons such as life expectancy and body mass index causes this surgical procedure to be performed more frequently. The knee joint which is innervated by the femoral, obturator, sciatic nerves and their branches has a complicated innervation and the pain following total knee arthrplasty is quite severe. It is aimed to provide effective analgesia by blocking these nerves or terminal branches with various peripheral nerve blockade methods under USG guidance. In recent years, interest in studies aiming to block these nerves with a single injection has been increasing. 4 in 1 block is a new technique applied from a single injection point to block the saphenous, obturator, sciatic and vastus medialis nerves that innervate the knee joint. Fascia iliaca compartment block is a reliable technique applied from a single injection point to block the femoral, lateral femoral cutaneous and obturator nerves behind the fascia iliaca.

Patients who will undergo elective total knee arthroplasty surgery under spinal anesthesia will be included in the study according to the postoperative analgesia method applied: Group Control, Group FICB and Group 4in1. Peripheral nerve block will be performed with 30 ml %0.25 bupivacaine for Group FICB and Group 4 in 1 patients. Peripheral nerve block will not be performed on Group Control patients. Patient-controlled analgesia will be given to all three groups in the postoperative period. PCA is a pain palliation method routinely used in all patients postoperatively. NRS score, PCA tramadol consumption, PCA demand, need for additional analgesia, patient satisfaction, nausea and vomiting will be monitored 24 hours postoperatively. The aim of this study is to compare the perioperative analgesic effectiveness of patients who underwent fascia iliaca compartment block and 4 in 1 block in total knee arthroplasty surgery, with each other and with the control group.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Ankara, Turkey, 06450
    • Department of Anesthesiology and Reanimation, University of Health Sciences, Diskapi Yıldırım Beyazit Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Study Population

Patients who undergone total knee arthroplasty

Description

Inclusion Criteria:

• With informed consent
• Elective total knee arthroplasty with spinal anesthesia
• Oriented and cooperative
• ASA Classification I-II-III
• 18-85 years old

Exclusion Criteria:

• Anticoagulant medication
• Coagulopathy
• Infection at the site of peripheral nerve block application
• Allergy to local anesthetics
• Pregnant or suspected pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Group Control; Peripheral nerve block will not be performed on Group Control patients.	Other: Control; Peripheral nerve block will not be performed on Group Control patients.
Other: Group FICB; FICB will be performed with 30 ml %0.25 bupivacaine for Group FICB patients.	Other: FICB; FICB is applied to the patients after spinal anesthesia.
Other: Group 4 IN 1; 4 in 1 block will be performed with 30 ml %0.25 bupivacaine for Group 4 IN 1 patients.	Other: 4 in 1 block; 4 in 1 block is applied to the patients after spinal anesthesia.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total tramadol consumption in 24 hours (mg)	Total tramadol consumption used in the first 24 hours postoperatively	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain on the Numeric Rating Scale (NRS)	NRS range was from 0-10 with being no pain and 10 the worst pain possible.	0 hours postoperatively
Pain on the Numeric Rating Scale (NRS)	NRS range was from 0-10 with being no pain and 10 the worst pain possible.	1 hours postoperatively
Pain on the Numeric Rating Scale (NRS)	NRS range was from 0-10 with being no pain and 10 the worst pain possible.	4 hours postoperatively
Pain on the Numeric Rating Scale (NRS)	NRS range was from 0-10 with being no pain and 10 the worst pain possible.	8 hours postoperatively
Pain on the Numeric Rating Scale (NRS)	NRS range was from 0-10 with being no pain and 10 the worst pain possible.	12 hours postoperatively
Pain on the Numeric Rating Scale (NRS)	NRS range was from 0-10 with being no pain and 10 the worst pain possible.	24 hours postoperatively
Rescue Analgesic	Consumption of rescue analgesic used after 24 hours postoperatively.	24 hours postoperatively
Patient satisfaction	The patient is satisfied or dissatisfied	24 hours postoperatively

Collaborators and Investigators

• Sponsor: Diskapi Yildirim Beyazit Education and Research Hospital

Publications and helpful links

General Publications

• Roy R, Agarwal G, Pradhan C, Kuanardr D, Mallick DJ. Ultrasound guided 4 in 1 block - a newer, single injection technique for complete postoperative analgesia for knee and below knee surgeries. Anaesthesia, Pain & Intensive Care. 2018;22(1):87-92.
• Kanadli H, Dogru S, Karaman T, Karaman S, Tapar H, Sahin A, Asci M, Kanadli KA, Suren M. Comparison of the efficacy of femoral nerve block and fascia iliaca compartment block in patients with total knee replacement. Minerva Anestesiol. 2018 Oct;84(10):1134-1141. doi: 10.23736/S0375-9393.18.12062-1. Epub 2018 Jan 16.

Study record dates

Study Major Dates

• Study Start (Actual): May 30, 2024
• Primary Completion (Actual): July 1, 2024
• Study Completion (Actual): July 8, 2024

Study Registration Dates

• First Submitted: May 24, 2024
• First Submitted That Met QC Criteria: May 24, 2024
• First Posted (Actual): May 30, 2024

Study Record Updates

• Last Update Posted (Actual): June 29, 2025
• Last Update Submitted That Met QC Criteria: June 25, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Total knee arthroplasty; FICB; 4 in 1 block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pain, Postoperative
• Other Study ID Numbers: İsa Öteleş

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No