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      Effects of fascia iliaca compartment block combined with general laryngeal mask airway anesthesia in children undergoing femoral fracture surgery: a randomized trial

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          Abstract

          Background

          Postoperative agitation after general anesthesia is a common complication in children; however, pain or uncomfortable feeling is the main reason of emergence agitation. Here, we have investigated the effects of fascia iliaca compartment block (FICB) combined with general laryngeal mask airway (LMA) anesthesia in children undergoing femoral surgery.

          Methods

          Eighty children undergoing femoral surgery were randomly divided into two groups: FICB + LMA group and control group (n=40). The FICB + LMA group received FICB combined with general LMA anesthesia, and the control group received tracheal intubation general anesthesia alone. Anesthesia was maintained with nitrous oxide and sevoflurane. Hemodynamic parameters were monitored, and pain was assessed by verbal numeric score within 24 hours postoperatively. Time to extubation, time to discharge from the postanesthesia care unit and postoperative complications were recorded.

          Results

          Hemodynamic parameters were more stable in the FICB + LMA group than in the control group during anesthesia induction ( P<0.05). Verbal numeric score values were lower in the FICB + LMA group than in the control group at 2–8 hours postoperatively ( P>0.05). Compared with the control group, the time to extubation and time to discharge from postanesthesia care unit were shorter in the FICB + LMA group ( P<0.05). Additionally, postoperative complications were less in the FICB + LMA group.

          Conclusion

          The FICB combined with general LMA anesthesia may provide intra- and postoperative analgesia, shorten emergence time and reduce postoperative agitation in children undergoing femoral surgery.

          Trial registration

          This study is registered at http://www.chictr.org.cn (registration number: ChiCTR-IOR-17012725).

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          Most cited references 16

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          Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial.

          Hip fracture patients are in severe pain upon arrival at the emergency department. Pain treatment is traditionally based on systemic opioids. No study has examined the effect of fascia iliaca compartment blockade (FICB) in acute hip fracture pain management within a double-blind, randomized setup. Forty-eight patients with suspected hip fracture were included immediately after arrival in the emergency department, before x-ray confirmation of their fracture. Included patients were randomly assigned to two groups of 24. In the FICB group, the patients received an FICB with 1.0% mepivacaine and a placebo intramuscular injection of isotonic saline. In the morphine group, the patients received a placebo FICB with 0.9% saline and an intramuscular injection of 0.1 mg/kg morphine. Patients received intravenous rescue morphine when necessary. Maximum pain relief was superior in the FICB group both at rest (P < 0.01) and on movement (P = 0.02). The median total morphine consumption was 0 mg (interquartile range, 0-0 mg) in the FICB group and 6 mg (interquartile range, 5-7 mg) in the morphine group (P < 0.01). More patients (P = 0.05) were sedated in the morphine group at 180 min after block placement as compared with the FICB group. Pain relief was superior at all times and at all measurements in the FICB group. The study supports the use of FICB in acute management of hip fracture pain because it is an effective, easily learned procedure that also may reduce opioid side effects in this fragile, elderly group of patients.
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            Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study

            Background Recent studies have indicated that unmanaged pain, both acute and chronic, can affect mental status and might precipitate delirium, especially in elderly patients with hip fractures. The aim of this study was to assess the effectiveness of fascia iliaca compartment block (FICB) for prevention of perioperative delirium in hip surgery patients who were at intermediate or high risk for this complication. Materials and methods On admission, all included patients were divided into three groups according to low, intermediate or high risk for perioperative delirium. Eligible patients (those classified as at intermediate or high risk for developing delirium) were sequentially randomly assigned to study treatment (FICB prophylaxis or placebo) according to a computer-generated randomization code. The primary outcome was perioperative delirium. Diagnosis of the syndrome was defined using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and Confusion Assessment Method (CAM) criteria. Secondary outcome variables were severity of delirium and delirium duration. Results Delirium occurred in 33 (15.94%) out of 207 patients randomized to FICB prophylaxis or the placebo group. Incidence of delirium in the FICB prophylaxis group was 10.78% (11/102), significantly different from the incidence (23.8%, 25/105) in the placebo group [relative risk 0.45, 95% confidence interval (CI) 0.23–0.87]. Nine of 17 patients with high risk for delirium and included in the FICB prophylaxis group developed delirium, whereas 10 of 16 high-risk patients included in the placebo group became delirious (relative risk 0.84, CI 0.47–1.52). Two of 85 patients with intermediate risk for delirium and included in the FICB prophylaxis group developed delirium, whereas 15 of 89 intermediate-risk patients included in the placebo group became delirious (relative risk 0.13, CI 0.03–0.53). Severity of delirium according to the highest value of the DRSR-98 during an episode with delirium in patients in the FICB prophylaxis group was on average 14.34, versus 18.61 in the placebo group (mean difference 4.27, 95% CI 1.8–5.64, P < 0.001). Mean duration of delirium in the FICB prophylaxis group was significantly shorter than in the placebo group (FICB 5.22 days versus placebo 10.97 days, 95% CI 3.87–7.62, P < 0.001). Conclusion No significant difference was found among high-risk patients between FICB prophylaxis and placebo groups in terms of delirium incidence. However, FICB prophylaxis significantly prevented delirium occurrence in intermediate-risk patients. Thus FICB prophylaxis could be beneficial, particularly for intermediate-risk patients.
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              Comparison of the fascia iliaca compartment block with the 3-in-1 block in children.

              A new single injection procedure, the fascia iliaca compartment block, is described for blocking the femoral, lateral cutaneous, and obturator nerves. The technique consists of injecting a local anesthetic immediately behind the fascia iliaca at the union of the lateral with the two medial thirds of the inguinal ligament, and forcing it upward by finger compression. This block was prospectively evaluated in 60 pediatric patients aged 0.7 to 17 years undergoing surgery of the lower limb, and then compared with a similar group of 60 children given a 3-in-1 block. Adequate analgesia was only obtained in 20% of the patients given 3-in-1 blocks (group 1), whereas the fascia iliaca compartment block proved to be easy, free of complications, and effective in more than 90% of patients (group 2). Such a high failure rate in group 1 was not due to misplacement of the needle since a femoral nerve block developed in all patients. Therefore it is unlikely that the local anesthetic can spread rostrally towards the lumbar plexus then return peripherally along the issuing nerves, and this was, indeed, not confirmed by radiological findings. In the authors' opinion, a multieffective block can only develop when the local anesthetic is introduced behind the fascia iliaca, which circumscribes a potential space where the femoral, lateral cutaneous, and obturator nerves run for a considerable part of their course. This report shows that deliberately injecting this space almost always results in an easy and effective block of these three nerves. The fascia iliaca compartment block can be recommended for use in children.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                08 November 2018
                : 11
                : 2821-2826
                Affiliations
                [1 ]Department of Anesthesiology, Huadu District People’s Hospital, Southern Medical University, Guangzhou 510800, Guangdong China
                [2 ]Department of General Surgery, The People’s Hospital of Xiaochang, Xiaogan 432900, Hubei, China
                [3 ]School of Medicine, Jiaxing University, Jiaxing 314000, Zhejiang, China, 13757370679@ 123456163.com
                Author notes
                Correspondence: Z Wang, School of Medicine, Jiaxing University, 188 Jiahang Road, Jiaxing 314000, Zhejiang, China, Tel +86 573 272 0085, Email 13757370679@ 123456163.com
                Article
                jpr-11-2821
                10.2147/JPR.S177122
                6235337
                30519084
                © 2018 Zhong et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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