Fascia Iliaca Compartment Block in Total Knee Arthroplasty With Intra-Articular Injection

Postoperative pain management is of great importance in orthopedic surgeries. Inadequate analgesia following total knee arthroplasty increases the risk of side effects such as thromboembolism, myocardial ischemia, pulmonary dysfunction, paralytic ileus, urinary retention, and postoperative bleeding, thereby prolonging hospital stays.

Recently, fascia iliaca compartment block (FICB) has been frequently used to treat pain following knee replacement surgery. However, there are only a limited number of studies demonstrating the effectiveness of this method for postoperative analgesia. Sensory innervation of the lower extremity is primarily provided by four main nerves and their branches. These are the sciatic nerve, femoral nerve, obturator nerve, and lateral femoral cutaneous nerve. FICB is a compartment block in which local anesthetic is injected under the iliac fascia to block the femoral nerve, obturator nerve, and lateral femoral cutaneous nerve. The iliac fascia is the second fascial plane encountered when examining the proximal lower extremity with ultrasound (USG), extending immediately beneath the fascia latae. The goal is to place the needle tip under the iliac fascia, a few centimeters away from the femoral artery. Then, a single dose of local anesthetic can be administered under the iliac fascia, or a catheter can be placed in this area with ultrasound guidance.

Cocktails containing local anesthetic, narcotic analgesic, epinephrine, methylprednisolone, and cefuroxime are injected periarticularly for the preemptive treatment of pain following knee replacement surgery. This method, one of the multimodal protocols, is used to minimize the use of parenteral narcotics in order to protect against side effects.

Regional blocks are simple techniques that not only improve postoperative pain control but also reduce postoperative opioid requirements, shorten hospital stays, increase patient satisfaction, and lead to better clinical outcomes after total knee arthroplasty.

In our clinic, continuous fascia iliaca compartment block is applied for postoperative analgesia in total knee arthroplasty cases. The aim of this study is to retrospectively investigate the effect of continuous fascia iliaca compartment block in addition to intraoperative intra-articular injection on postoperative analgesia, postoperative bleeding and patient satisfaction in total knee arthroplasty cases.

Inclusion criteria

• Total knee arthroplasty cases with or without continuous fascia iliaca compartment block
• Patients with ASA criteria 1-2-3

Exclusion criteria

• Patients whose records cannot be accessed
• Patients with ASA criteria 4-5