Effectiveness of fascia iliaca compartment block for post-operative analgesia following hip surgery at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Pain following hip surgery causes significant patient discomfort. In addition to other analgesic options, the use of regional blocks offer localized and long-term pain relief. Fascia iliaca compartment block (FICB) is one such regional block that has been shown to be successful in pain control following hip surgery. There is minimal use of this block at Moi Teaching and Referral Hospital (MRTH). The aim of this study was to assess the effectiveness of FICB for analgesia when performed by an orthopedic resident following hip surgery. Objective: To assess the effectiveness of FICB as part of multimodal analgesia for postoperative analgesia following hip surgery at MTRH. Methods: A randomized control trial was carried out from 1st July 2017 to 30th March 2019 at MTRH. Seventy adult patients who met the inclusion criteria for FICB were enrolled in the study after obtaining an informed consent. Thirty-five patients were randomized into Group A and received FICB and the other 35 patients who were randomized into Group B did not receive FICB. The FICB was administered by a trained orthopedic resident, using the ‗two pop‘ technique, in the post-anesthetic care unit. The standard dose of 0.35ml/kg of 0.5% bupivacaine was used for the block. Pain was assessed using the Numerical Rating Scale at 2, 4, 6 and 8 hours after surgery with the limb in anatomical position and at 150 flexion. The data collectors were blinded. A failed FICB block was defined as less than 3-point drop in NRS and normal sensation to cold metallic object on examination. All patients received intravenous morphine and paracetamol at a dose of 0.1mg/kg and 15mg/kg respectively and intramuscular diclofenac at a dose of 3mg/kg for postoperative analgesia. Data were analyzed using STATA version 13. T-test was used to compare the mean pain scores between the two groups. Results: At anatomical position, the mean pain scores at 2, 4 and 6 hours for group A were 4.5(±1.9), 2.7 (±2.1) and 3.9 (±1.5), while for group B were 8.4 (±0.8), 7.1(±1.1) and 6.0 (±1.6) (p<0.001). With the limb at 150 flexion, the mean pain scores at 2, 4 and 6 hours for group A were 5.5 (±1.5), 3.2( ±2.9) and 4.0 (±2.0) while for group B were 9.2 (±0.6), 8.4 (±1.0) and 7.1(±1.2) (p<0.001). There was no statistical significant difference in pain scores between the groups at 8 hours with patients limbs in anatomical position (p=0.659) and with the patients limbs in 150 flexion (p=0.46). The failure rate for FICB was 17.1% (n=6). Conclusion: Facia iliaca compartment block offered effective analgesia for the first six hours following hip surgery. The failure rate of FICB was low at 17.1%. Recommendation: Fascia iliaca compartment block be adopted into the multimodal analgesia following hip surgery at MTRH. Further studies looking at longer acting analgesic options be conducted.