Background and Aims Suprainguinal fascia iliaca compartment block (SiFiB) is a valuable analgesic technique for hip surgery1–3. Studies show that high volumes of solutions in this space reach lumbar plexus roots and thus, these blocks tend to use high volumes of low-concentration local anesthetics (e.g. 40 mL 0,125% levobupivacaine) spread all over the area covered by the solution4. To achieve higher selectivity on nerve roots, we propose a novel technique using low volumes of hypobaric local anesthetics within a high volume of hyperbaric solution after fascial hydrodissection of the iliacus muscle (Figure 1).
This study aimed to assess the effects of a lumbar plexus block via an iliofascial approach using heterobaric solutions.
Methods A case series study using ultrasound-guided SiFiB was performed in 11 patients following hip replacement surgery. 40 mL of a 32.500 g/L glucosaline solution was administered ensuring compartimental hydrodissection. Cephalad spread was confirmed using ultrasonography (Figure 2). Subsequently, 7 mL of 8.600 g/L hypobaric 0,5% levobupivacaine were administered inside the fluid pocket (density difference of 23.900 g/dL, the same between cerebrospinal fluid and hyperbaric bupivacaine). The patient was then seated up 90° for optimal distribution.
Results 24-hours visual analog scale (VAS) and Quality of Recovery 15 score (QoR-15) mean scores were 1/3 (±0.65/1.13) and 70.7 (±3.93) respectively. Mean Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) score was 53.5 (±4.48). No adverse effects were reported. (Table 1)
Conclusions SiFiB with optimized baricity solutions may be a promising technique for analgesia in hip replacement surgery.