Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: A randomised double-blinded trial

Ashok Jadon, Khalid Mohsin, Rajendra K Sahoo, Swastika Chakraborty, Neelam Sinha, Apoorva Bakshi, Ashok Jadon, Khalid Mohsin, Rajendra K Sahoo, Swastika Chakraborty, Neelam Sinha, Apoorva Bakshi

Abstract

Background and aims: Regional analgesic techniques such as supra-inguinal fascia-iliaca compartment block (S-FICB) and pericapsular nerve group (PENG) block have been found to be effective in providing good pain relief in hip-fracture patients. However, comparative studies between PENG and S-FICB are lacking. The aim of this study was to compare the analgesic efficacy of S-FICB and PENG block and assess their efficacy in optimal patient positioning for spinal anaesthesia.

Methods: A prospective randomised double-blind study was conducted in 66 patients randomly divided to receive either S-FICB or PENG block under ultrasound guidance. Primary outcome measures were numerical rating scale (NRS) pain score at rest and on passive 15° limb lifting, 30 minutes after the block and ease of spinal positioning. The secondary outcome measures were NRS over 24 hours, amount of tramadol used (number of rescue doses), patients' satisfaction and block-related complications. The results were analysed using statistical software (MedCalc version 19.2.1). Continuous and categorical data were analysed using appropriate statistical analysis and P < 0.05 was considered significant.

Results: Post-block, the NRS score decreased significantly in PENG and S-FICB groups at rest and movement (P < 0.0001). The EOSP score was significantly better in PENG group (P < 0.0001). First analgesic request and pain relief in the first 24-hour period were similar between the groups (P = 0.524).

Conclusion: PENG block provided better pain relief and ease of positing during SA in patients with fractured hip scheduled for hip surgery.

Keywords: Anaesthesia; fascia; femoral nerve; hip fractures; nerve block; pain management; spinal.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2021 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
(a) Sonoanatomy of S-FICB; (b) spread of local anaesthetic below the fascia iliaca; (c) deep circumflex iliac artery just above the fascia iliaca; (d) Sonoanatomy of PENG block, *showing local anaesthetic spread; (e) trajectory of needle and local anaesthetic spread between psoas tendon and pubic ramus. ASIS- anterior superior iliac spine, AIIS- anterior inferior iliac spine, A- deep circumflex iliac artery, FA- femoral artery, FI-fascia iliaca, IOM-internal oblique muscle, IPE-ilio-pectineal eminence, SM-sartorius muscle, PT-psoas tendon
Figure 2
Figure 2
CONSORT flow diagram for enrolment, group allocation, follow-up and analysis

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