# Ultrasound-Guided Suprainguinal Versus Infrainguinal Fascia Iliaca Compartment Block for Postoperative Analgesia After Total Knee Replacement: A Prospective Randomized Trial

## TL;DR

This study compares two methods of nerve block for pain relief after knee surgery, finding that the suprainguinal approach provides better pain control and reduces opioid use.

## Contribution

The study provides new evidence that the suprainguinal fascia iliaca compartment block is more effective for postoperative analgesia than the infrainguinal approach after total knee replacement.

## Key findings

- SFICB significantly reduced tramadol consumption compared to IFICB.
- Pain intensity was lower with SFICB six hours after surgery.
- Time to first analgesic request was longer with SFICB.

## Abstract

Background: Fascia iliaca compartment block (FICB) can be achieved using suprainguinal (SFICB) or infrainguinal (IFICB) approaches. This study compares postoperative analgesia of SFICB and IFICB after total knee replacement (TKR).

Methods: This prospective, randomized, single-blind study was conducted on 60 adult patients undergoing unilateral TKR under spinal anesthesia. Patients were randomly allocated into two groups: Group S received SFICB with 30 mL of 0.25% levobupivacaine with 2 mL (8 mg) dexamethasone, while Group I received IFICB with the same drugs after surgery. The primary outcome variable was 24-hour cumulative tramadol consumption. Secondary outcome variables included pain intensity, complications, hemodynamic variations, and time to first rescue analgesic request.

Results: Tramadol consumption was significantly lower with SFICB (86.67±34.57 versus 34.57±33.95 mg, p=0.006). Pain intensity was lower with SFICB after six hours of surgery. Time to first analgesic request was also longer with SFICB (12.83±3.80 versus 10.12±2.98 hours, p=0.003). Time taken for administering the blocks (16.20±2.66 versus 17.17±3.13 minutes), complications, and hemodynamic variations were statistically similar between the groups.

Conclusion: SFICB provides superior postoperative analgesia compared to IFICB in patients undergoing TKR, with reduced opioid requirement and prolonged analgesia duration.