Impact Of The High Fascia Iliaca Compartment Block On Analygesia During Lumbar Anesthesia With Lateral Recumbent Position In Hip Fracture Surgery

Objective: Compare the analygesia effect of fascia iliaca compartment block(FICB)with different routes and femoral nerve block(FNB)during lumbar anesthesia with lateral recumbent position in hip fracture surgery,as well as the nerve block effect and postoperative related indexes,in order to provide reference for further clinical research and practice of FICB.Methods: A total of 60 patients with hip fracture surgery from October,2020 to June,2021 at the Hospital were enrolled.Patients were randomly assigned into the femoral nerve block combined with lumbar anesthesia group(FNB group),the fascia iliaca compartment block combined with lumbar anesthesia group(F-FICB group),and the high fascia iliaca compartment block combined with lumbar anesthesia group(H-FICB group)in order to receive different types of lumbar anesthesia.The onset time of sensory block in the innervated areas of the three main nerves(femoral nerve,lateral femoral cutaneous nerve and obturator nerve)for hip surgery,the extent of block and changes in muscle strength of the quadriceps and adductor muscles,(pain)VAS scores,patient satisfaction with anesthesia and postoperative adverse reactions were observed.Statistical analysis was performed on all the indicators.The following data were monitored and recorded during the trial:(1)general information of patients;(2)VAS scores at rest condition before the analgesic intervention and 3,5,8,and 10 minutes post the analgesic intervention,VAS scores during positioning at exercise condition;(3)quality of positioning;(4)results of nerve block sensory assessment;(5)results of motor function testing;(6)the incidence of postoperative adverse effects.Results:(1)The analgesic interventions of F-FICB,H-FICB,and FNB all provided favorable analgesic and nerve block effects,with the H-FICB intervention performing the best.(2)At 3 and 5 minutes after the analgesic intervention,the FNB intervention had the fastest response and showed better analgesic effect;the H-FICB intervention had the moderate analgesic effect after the FNB intervention;and the F-FICB intervention had the weakest analgesic effect.(3)At 8 and 10 minutes after the analgesic intervention,the H-FICB intervention showed a better analgesic effect;followed by the analgesic effect induced by FNB intervention;the analgesic effect of F-FICB still showed the weakest analgesic effect.(4)The analgesic effect of H-FICB remained the best during positioning at exercise condition;(5)H-FICB interventions performed the best in the sensory assessment of nerve block and motor function detection.(6)The incidence of postoperative adverse for patients in the three groups decreased with the order of FNB group,H-FICB group and F-FICB group,but no statistical difference was observed(P>0.05),and the satisfaction rate of patients in all three groups was relatively high,the quality of positioning showed a slightly increasing trend in the order of the FNB group,the F-FICB group,and the H-FICB group(P>0.05).Conclusions: All three different analgesic interventions,F-FICB,H-FICB and FNB,can provide favorable analgesic effect,and the analgesic effect of FNB is faster in a short time after the intervention,with the extension of time post intervention,H-FICB shows better analgesic effect during lumbar anesthesia with lateral recumbent position in hip fracture surgery,while F-FICB still shows relatively weak results.In addition,H-FICB intervention also showed favorable postoperative recovery effects.It suggests the potential of the H-FICB intervention to be used in clinical practice.