Evaluation Of Clinical Effect Of Different Injection Speeds On Fascia Iliaca Compartment Block

Objective:Fascia iliaca compartment block（FICB）can provide better analgesia for patients with hip surgery.During fascial space block,local anesthetics spread to the target nerve along the path of least resistance.Path resistance and injection speed will affect the diffusion of local anesthetics to the target nerve.This study focused on patients with unilateral total hip arthroplasty（THA）who underwent FICB,and explored whether the speed of injection could affect the success rate of sensory block,the duration of sensory block,and the analgesic effect of the patients.Methods:Ninety patients with unilateral total hip replacement from January 2019 to September 2019 were included.According to the random number table method,90patients were divided into three groups:group A,group B,and group C,30 cases in each group.The speed of each group was:A Group 400ml/h,Group B 600ml/h,Group C 1200ml/h..The concentration of ropivacaine in all three groups was 0.25%,and the hourglass sign FICB was performed before general anesthesia.40 ml of ropivacaine was pumped at different injection speeds.General anesthesia was performed after 30 minutes.Sustained intravenous pump analgesia（1.5μg/kg sufentanil+100 mg flurbiprofen ester,background dose:3ml/h）was performed after surgery.Recorded the main outcomes:the femoral nerve（FN）,Lateral femoral cutaneous nerve（LFCN）,and obturator nerve（ON）sensory block success rates in each group at 30 minutes after the block;the visual analog scale（VAS）at rest before and 30minutes after the block;the duration of postoperative sensory block;VAS score of patients at rest and in motion at 4h,8h,12h,24h after surgery.The secondary outcomes were the total amount of general anesthetics during the operation,VAS score of admission to the operation（T₀）,20 minutes after nerve block（T₁）,post-induction（T₂）,lateral position（T₃）,incision（T₄）,30 minutes during operation（T₅）,completion of operation（T₆）,immediate extubation（T₇）,exit of PACU（T₈）,mean arterial pressure（MAP）and heart rate（HR）at each time point,the patient’s motion block score,incidence of postoperative adverse reactions such as local anesthetic toxicity,nausea and vomiting,respiratory depression,constipation,skin pruritus,and postoperative fall,patient’s and family’s satisfaction.Results:There was no statistical difference in the success rate and duration of sensory block in the three groups（P>0.05）.In the resting state:The differences in VAS score between 30 minutes after block and at various time points after surgery were statistically significant between groups（P<0.05）.Compared with group A,group C had 30 minutes after block and postoperatively 4hVAS score was statistically significant（P<0.05）.In the state of motion:Compared with group A,the difference in VAS score was statistically significant at 12h postoperatively（P<0.05）.The VAS score of group C were lower than group A at 4h,8h,and 24h postoperatively,but there was no statistical difference（P>0.05）.MAP and HR were not statistically significant at each time point in the three groups.There were no statistical significant differences in the incidence of adverse reactions and the satisfaction of patient’s and family’s satisfaction among the three groups（P>0.05）.Conclusion:1.Different injection speeds will not affect the success rate and duration of FICB sensory block under ultrasound guidance.2.When the injection speed is 1200ml/h,it can provide patients with better analgesic effects.