Comparison of two ultrasound-guided approaches for the fascia iliaca compartment block in patients with a proximal femur fracture

Background: Fascia iliaca compartment block (FICB) is a popular block in patients with hip injuries. It gives good postinjury analgesia and helps in positioning for neuraxial blockade before the surgery. Aims and Objectives : The study aims to compare two approaches (parallel versus perpendicular) of ultrasound (USG)guided FICB in patients undergoing proximal femur fracture surgeries. The primary objective was to compare the time to do ultrasonic imaging, time to perform the FICB, and total block time. The secondary objective was to compare the time to loss of sensation, first rescue analgesia, pain score and occurrence of adverse events. Materials and Methods: Fiftyone patients were allocated into two groups in this prospective observational study. In parallel group (Group A) (n = 25), the USG probe was kept parallel to the inguinal ligament, and in the perpendicular group (Group B) (n = 26), a probe was placed perpendicular to the inguinal ligament. Both groups received equal doses of the drug. The time to achieve ultrasonic imaging, time to perform the block, total block time, loss of sensation within the distribution of lateral cutaneous nerve and the femoral nerve was noted. Time to first rescue analgesia, pain score and adverse events were also noted. Results: Group A approach was quicker to perform than the perpendicular approach (5.1 ± 0.7 vs. 7.3 ± 1.2 min) (P < 0.0001). The imaging time of Group A was shorter than Group B (3.2 ± 0.3 vs. 5.3 ± 0.7 min) (P < 0.0001). The success rate of sensory loss of lateral cutaneous nerve was quicker and better with Group B (88% vs. 100%). No statistical differences were noted in postoperative pain score, time of rescue analgesia, the incidence of complications, and the patient's satisfaction score between the two groups. Conclusion: The perpendicular approach of USGguided FICB may offer a better blocking effect of lateral cutaneous nerve and longer duration of block time, but the parallel approach offers better and quicker ultrasonic imaging.