Editorial Commentary: Quadratus Lumborum Analgesia for Hip Arthroscopy: The New Kid on the (Nerve) Block

Quadratus lumborum (QL) nerve block is a new technique aimed to improve perioperative analgesia for patients undergoing hip arthroscopy. The QL block targets nerve roots from the lumbar plexus supplying the hip and is an alternative to the fascia iliaca compartment block, which has been shown to have variable effects on pain control while increasing motor weakness and postoperative fall risk. Although a recent Level I study showed decreased opioid consumption without increased motor weakness after QL block compared to sham block, another Level I study reported contrasting results with QL block demonstrating no improvement in pain control or opioid consumption compared to a multimodal pain regime after hip arthroscopy. These differing conclusions from high-level studies indicate further research is needed for QL block and that investigation of other potential nerve block options for hip arthroscopy patients, such as the PENG block, is warranted.     

Editorial Commentary: The Optimal Nerve Block for Hip Arthroscopy Is Undetermined

The optimal nerve block to help reduce pain after hip arthroscopy is undetermined. The fascia iliaca block was en vogue but may result in weakness, neuropathy, and equivocal pain outcomes. Other options include blocks to the femoral nerve, the lumbar plexus, the quadratus lumborum, and, more recently, the pericapsular nerve group block (PENG), in which ultrasound guidance allows injection under the iliopsoas muscle to affect the accessory obturator nerve and the articular branches of the femoral nerve. PENG block should not result in weakness, but weakness has been reported after PENG block for total hip arthroplasty, and falls could be a risk and a concern. The arthroplasty literature also suggests the PENG block adds little benefit to intra-articular injection beyond the recovery room and is comparable with a fascia iliac block. Perhaps the PENG block could show benefit in select cases such as for severe postoperative pain or in patients with anticipated pain control challenges. Until an ideal block for hip arthroscopy is determined, a patient tailored approach is indicated.     

The analgesic efficacy of continuous fascia iliaca block vs. continuous psoas compartment block after hip surgery: A comparative study

BackgroundBoth psoas compartment block and fascia iliaca compartment block have been shown to be reliable blocks for postoperative pain relief for procedures involving the hip joint. This study evaluated the efficacy of continuous psoas compartment block with continuous fascia iliaca block for postoperative analgesia after hip surgery.MethodsIn randomized blinded study Forty, ASA I–III patients aged 30–75 years, with BMI less than 40, scheduled for hip surgery, were divided to one of two groups. Group P: continuous psoas compartment block (n = 18) and group F: continuous fascia iliaca block (n = 19). Standard general anesthesia was induced after finishing the block technique. After recovery 30 ml of 0.125% levobupivacaine was injected through the catheter to all patients. Postoperative 24 h meperidine consumption, patient satisfaction, visual analogue scale pain scores at (1, 6, 12, 18, and 24 h) postoperative, postoperative hemodynamics (HR and MAp), evidence of sensory and motor blockades, and incidence of adverse effects were recorded.ResultsThere was no significant difference between the two groups in 24 h postoperative meperidine requirements, postoperative VAS, patient satisfaction, postoperative hemodynamics, and distribution of sensory and motor block of (femoral, lateral femoral cutaneous, and obturator nerves). The epidural anesthesia occurred in two patients in psoas group (11%).ConclusionBoth continuous fascia iliaca block and continuous psoas compartment block were comparable in providing safe and effective analgesia after hip surgery.     

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.     

Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation

Background

Fascia iliaca compartment block is used for hip fractures in order to reduce pain, the need for systemic analgesia, and prevent delirium, on this basis. This systematic review was conducted to investigate the analgesic and adverse effects of fascia iliaca block on hip fracture in adults when applied before operation.

超声引导髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞在老年患者髋关节置换术术后镇痛中的作用

目的 观察超声引导下髂筋膜腔隙与髂腹下/髂腹股沟神经联合阻滞在老年患者全髋关节置换术术后镇痛的作用. 方法 选择2015年1月～2015年11月全身麻醉下行单侧前外侧入路全髋关节置换术的患者50例,年龄61～75岁,ASA分级Ⅱ、Ⅲ级,采用随机数字表法将患者分为两组(每组25例):单纯髂筋膜间隙阻滞组(单纯组)和髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞组(复合组).手术结束后即刻行患侧超声引导下神经阻滞.单纯组于髂筋膜腔隙注射0.3％罗哌卡因30 ml;复合组分别于髂筋膜腔隙与髂腹下/髂腹股沟注射0.3％罗哌卡因15 ml.记录患者一般情况,术后6、12、18、24 h患者静息及运动VAS评分,超声成像时间,穿刺注药时间,患者自控镇痛(patient controlled analgesia,PCA)芬太尼累计用量及术后镇痛相关副作用的发生情况. 结果 两组患者一般情况差异无统计学意义(P＞0.05).两组患者术后各时点静息VAS评分差异均无统计学意义(P＞0.05).复合组运动VAS评分在术后6 h [(3.8±0.9)分]和12 h[(3.6±1.3)分]时点较单纯组[(5.5±11)分和(5.3±1.0)分]降低(P＜0.05);在术后18h和24 h时点,2组运动VAS评分差异均无统计学意义(P＞0.05).两组患者超声成像时间和穿刺注药时间差异均无统计学意义(P＞0.05).复合组PCA芬太尼累计用量[(0.54±0.03) mg]较单纯组[(0.69±0.05) mg]降低(P＜0.05).两组患者术后镇痛相关副作用发生率差异无统计学意义(P＞0.05). 结论 在老年患者髋关节置换术后,超声引导髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞可安全、有效地用于术后镇痛,显著缓解患者甲早期的运动疼痛同时减少芬太尼用量.     

Efficacy of the fascia iliaca compartment block vs continuous epidural infusion for analgesia following total knee replacement surgery

Background and objective: Total knee replacement causes moderate to severe postoperative pain. The aim of this trial was to compare postoperative analgesia from a fascia iliaca compartment block to continuous epidural analgesia following knee arthroplasty. Patients and Methods: Clinical trial enrolling patients in American Society of Anesthesiologists (ASA) classes 1 to 3 randomized to 2 groups. One group received spinal anesthesia plus a fascia iliaca compartment block with 0.1% bupivacaine at a rate of 10 mL/h. The second group received combined spinal-epidural anesthesia plus epidural analgesia with 0.1% bupivacaine in continuous infusion at a rate of 8 mL/h. Postoperative pain on a visual analog scale (VAS) at rest and on movement was recorded every 3 hours for the first 24 hours. Use of intravenous morphine and the adverse events were also recorded. Results: Forty patients (20 for each group) were enrolled. The distribution of age, weight, body mass index, sex, ASA class, duration of surgery, use of morphine, and the incidence of adverse effects were similar in the 2 groups. Postoperative VAS scores at rest and on movement were also similar. The incidence of arterial hypotension was higher in the epidural analgesia group. Conclusions: The fascia iliaca compartment block and continuous epidural infusion are similarly efficient in providing postoperative analgesia for patients after total knee replacement. The fascia iliaca compartment block is associated with a lower incidence of postoperative hemodynamic complications. Early, safe rehabilitation is facilitated by both analgesic techniques.     

A comparison of pre‐operative nerve stimulator‐guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture

We undertook a randomised, controlled trial to compare the analgesic efficacy and opioid sparing effect of nerve stimulator‐guided femoral nerve block with fascia iliaca compartment block in patients awaiting surgery for fractured neck of femur. Ten‐centimetre visual analogue pain scores were measured before and 2 h after the block and opioid consumption was recorded in the 12‐h period after the block. One hundred and ten patients were randomly assigned. Femoral nerve block provided superior pre‐operative analgesia for fractured neck of femur compared with fascia iliaca compartment block. The difference in the mean reduction of pain score after the block was 0.9 (95% CI 0–1.8); p = 0.047. Patients receiving a femoral nerve block required less morphine after the block than those receiving fascia iliaca compartment block (p = 0.041).     

The Efficacy and Safety of Regional Nerve Blocks in Total Hip Arthroplasty: Systematic Review and Direct Meta-Analysis

BackgroundRegional nerve blocks may be used as a component of a multimodal analgesic protocol to manage postoperative pain after primary total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after THA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.MethodsWe searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published prior to March 24, 2020 on fascia iliaca, lumbar plexus, and quadratus lumborum blocks in primary THA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks.ResultsAn initial critical appraisal of 3,382 publications yielded 11 publications representing the best available evidence for an analysis. Fascia iliaca, lumbar plexus, and quadratus lumborum blocks demonstrate the ability to reduce postoperative pain and opioid consumption. Among the available comparisons, no difference was noted between a regional nerve block or local periarticular anesthetic infiltration regarding postoperative pain and opioid consumption.ConclusionLocal periarticular anesthetic infiltration should be considered prior to a regional nerve block due to concerns over the safety and cost of regional nerve blocks. If a regional nerve block is used in primary THA, a fascia iliaca block is preferred over other blocks due to the differences in technical demands and risks associated with the alternative regional nerve blocks.     

Repeated psoas compartment blocks for the management of long-standing hip pain

BACKGROUND AND OBJECTIVES: The psoas compartment block is used to produce analgesia of the lumbar plexus mainly for hip and knee surgery. It has also been used for the management of a long-standing pain due to hip joint degeneration. CASE REPORT: A 55-year-old woman with severe left hip pain received repetitive psoas compartment blocks over 18 months. The blocks provided her with effective pain control. The quality and duration of the block was improved by the addition of opioid to the local anesthetic. CONCLUSION: We successfully performed repeated psoas compartment blocks with a local anesthetic and subsequently with added opioids, which produced substantial pain relief, especially after the addition of opioids.     

A modified fascia iliaca compartment block has significant morphine-sparing effect after total hip arthroplasty

We assessed whether a modified fascia iliaca compartment block in unilateral total hip arthroplasty provides a morphine-sparing effect in the first 24 hours. This involved a randomised, double blind study of 44 patients. Both groups received a modified fascia iliaca block with the trial group receiving 30 ml 0.5% bupivacaine with 1:200,000 adrenaline, 150 microg clonidine and 9 ml 0.9% saline and the control group receiving 40 ml 0.9% saline. Otherwise both groups received identical care with a subarachnoid block for operative anaesthesia. Patient-controlled morphine analgesia was commenced postoperatively and data were collected at three, six, 12 and 24 hours post commencement of surgery. We found that the trial group used less morphine at 12 and 24 hours (P < 0.001). The median morphine usage at 24 hours was 37.5 mg in the control patients and 22 mg in the trial patients. Pain scores were similar between groups. We conclude that a modified fascia iliaca compartment block has a significant morphine-sparing effect in unilateral total hip arthroplasty.     

超声引导下连续髂筋膜间隙阻滞用于老年髋部骨折患者围术期镇痛的研究

目的:研究超声引导下髂筋膜间隙阻滞对老年髋部骨折患者围手术期疼痛控制及术后并发症的影响。方法:选择2021年1月至2021年9月收治的老年髋部骨折手术患者127例,按照镇痛方法不同分为连续髂筋膜间隙阻滞组(F组)和静脉镇痛对照组(C组)。其中F组62例,男19例,女43例;年龄66~95(82.4±7.2)岁;股骨颈骨折25例,股骨转子间骨折37例。C组65例,男18例,女47例;年龄65~94(81.4±8.7)岁;股骨颈骨折29例,股骨转子间骨折36例。观察两组患者围术期不同时间点的疼痛视觉模拟评分(visual analogue scale,VAS)、简易精神状态评价量表(minimental state examination,MMSE)评分、警觉-镇静评分(observer''s assessment of alertness/sedation,OAA/S)、改良Bromage评分、术后并发症及患者住院期间情况。结果:F组实施阻滞后30 min、麻醉摆放体位时,术后6、24、48 h的静息及运动VAS低于C组(P<0.05)。F组术前12 h,术后1、3 d的MMSE评分及术后3 d的OAA/S评分高于C组(P<0.05)。F组不良反应发生率、需要额外镇痛人数低于C组(P<0.05)。F组围术期镇痛满意度及住院时间均优于C组(P<0.05)。两组患者在各时间点患肢Bromage评分及术后30 d死亡率比较,差异无统计学意义(P>0.05)。结论:超声引导下连续髂筋膜间隙阻滞可为老年髋部骨折患者提供安全、有效的围术期镇痛效果,改善术后认知功能,减少术后并发症,从而缩短住院时间,提高住院期间生活质量。     

Editorial Commentary: Neuraxial Anesthesia Improves Pain After Hip Arthroscopy but Risks Ambulatory Discharge Delay

Hip arthroscopy continues to be one of the fastest-growing orthopaedic procedures nationally, and pain control following these procedures can be challenging. As regional anesthesia techniques for this population have shown to have limited benefits, pain management for hip arthroscopy focused on multimodal analgesia and preventive analgesia, interventions that reduce postoperative hyperalgesia. The use of neuraxial anesthesia such as spinal and epidural anesthesia, established preventive analgesic anesthetic techniques, has demonstrated to improve postoperative pain in orthopaedic surgery when compared with general anesthesia. This promising finding highlights that despite potential disadvantages of neuraxial anesthesia, such as a small risk for complications or delayed resolution of the neuraxial block that could delay discharge, neuraxial anesthesia could be a suitable anesthetic technique for ambulatory orthopaedic surgery.     

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.     

改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的应用

目的观察改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的麻醉效果。方法选择择期行单侧大隐静脉高位结扎加抽剥术患者60例,男32例,女28例,年龄42~76岁,ASAⅠ或Ⅱ级,采用随机数字表法将其分为改良髂筋膜间隙联合腘窝坐骨神经阻滞组(N组)和硬膜外阻滞组(E组),每组30例。N组先行腘窝坐骨神经阻滞,再在超声图像上确认髂筋膜和股神经位置,先行股神经阻滞,再在同一穿刺点从缝匠肌内侧缘开始,由外向内沿髂筋膜下给1%利多卡因10ml和0.5%罗哌卡因10ml,同时超声探头在腹股沟韧带水平向内移动,内侧达股动脉上方;E组采用L2~3间隙行硬膜外阻滞。记录两组阻滞前(T0)、阻滞后10min(T1)、30min(T2)、60min(T3)的SBP、DBP及HR;记录两组阻滞完成时间、感觉阻滞起效时间、术中麻黄碱使用情况、麻醉效果及术后48h恶心呕吐、头痛及尿潴留发生情况。结果与T0时比较,T2时E组的SBP和DBP明显降低(P0.05),T2时N组SBP和DBP明显高于E组(P0.05);N组感觉阻滞起效时间明显短于E组、术中麻黄碱使用率明显低于E组(P0.05);E组整体麻醉效果优于N组(P0.05),但两组麻醉效果优良率差异无统计学意义;术后48hN组尿潴留发生率明显低于E组(P0.05)。结论改良髂筋膜间隙联合腘窝坐骨神经阻滞用于单侧大隐静脉高位结扎加抽剥术中,麻醉效果良好,较硬膜外阻滞具有血流动力学影响小、术后并发症少及适应证更广等优点。     

PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations

The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intra-operative intravenous dexamethasone 8–10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.     

Fascia iliaca compartment block for femoral bone fractures in prehospital care

BACKGROUND AND OBJECTIVES: The fascia iliaca compartment block provides a faster and more consistent simultaneous blockade of the lateral cutaneous and femoral nerves than the "3 in 1" block. We studied the effectiveness of this technique for analgesia after a femoral bone fracture in pre-hospital care. METHODS: Patients with an isolated femoral shaft fracture were included. A fascia iliaca compartment block was performed on all of them. Twenty milliliters of lidocaine 1.5 % with epinephrine were injected under the fascia iliaca. The intensity of pain was measured using a simplified verbal scale (SVS) from 0 (no pain) to 4 (extreme pain). The SVS was noted before the block was performed, 10 minutes later, and then on admission to the trauma care center. Sensory blockade was evaluated using cold perception in the lateral, medial, and internal part of the thigh 10 minutes after block performance and on arrival at the trauma care center. RESULTS: Twenty-seven patients were enrolled in this study. The SVS was 3 (3-4) before the block, 1 (0-2) 10 minutes after the block, and 0 (0-1) when arriving at the trauma care center (P <.05). The SVS was lower when the internal part of the thigh was blocked. CONCLUSION: The fascia iliaca compartment block is a simple, inexpensive, and effective method of prehospital analgesia for femoral shaft fracture. A sensory block of the internal part of the thigh is an early predictive sign of optimal pain relief.     

Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery

Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery.ObjectivesThe objectives of this study were designed to detect the effects of addition of dexmedetomidine to bupivacaine on the quality of blind fascia iliaca compartment block and its possible side effects in children undergoing fracture femur surgery.MethodsThis study was conducted on 28 children (2–6 years of age), scheduled for fracture femur surgery. Children were randomly allocated to receive either 0.25% bupivacaine 1 ml kg^?1 (B group), or 0.25% bupivacaine 1 ml kg^?1 with dexmedetomidine 2 μg kg^?1 (BD group). Anesthesia was maintained with sevoflurane 1–1.5 minimum alveolar concentration. Intraoperative sevoflurane concentration, hemodynamic, postoperative emergence delirium, sedation scores and pain scores were recorded. Duration of surgery and emergence time were recorded. Postoperative complications such as (nausea and vomiting, respiratory depression, purities, hypotension and bradycardia) were reported.ResultsCompared to the group B, patients received bupivacaine–dexmedetomidine for fascia iliaca compartment block had lower intraoperative sevoflurane concentration, higher sedation score, longer duration of postoperative analgesia, less use of rectal paracetamol for the first 24 h postoperatively and less number with postoperative agitation. No patients developed postoperative respiratory depression, purities, hypotension or bradycardia.ConclusionThe present study concluded that the combined use of bupivacaine–dexmedetomidine for fascia iliaca compartment block in children provided significant reduction of end-tidal sevoflurane concentration, remarkable hemodynamic stability, significant postoperative analgesia with lower postoperative analgesics requirements without any undesirable complications.     

区域阻滞麻醉技术在髋关节手术中的应用进展

随着超声技术在麻醉领域中的广泛应用和对髋关节神经支配的深入认识,越来越多的区域阻滞麻醉技术用于髋关节手术患者的麻醉与镇痛。本文就腰丛阻滞(LPB)、髂筋膜间隙阻滞(FICB)、腰方肌阻滞(QLB)、竖脊肌平面阻滞(ESPB)和髋关节囊周神经(PENG)阻滞的解剖及入路、临床应用和并发症等方面等进行综述,以探讨各种区域阻滞麻醉技术在髋关节手术中的应用进展。     

Comparison of continuous 3-in-1 and fascia Iliaca compartment blocks for postoperative analgesia: feasibility,catheter migration,distribution of sensory block,and analgesic efficacy

BACKGROUND AND OBJECTIVES: Efficacy and technical aspects of continuous 3-in-1 and fascia iliaca compartment blocks were compared. METHODS: Forty-four patients scheduled for cruciate ligament repair or femur surgery were randomly divided into 2 groups. After surgery with the patient anesthetized, catheters were placed for continuous 3-in-1 blocks by means of a nerve stimulator (group 1). In group 2, the catheter was inserted for continuous fascia iliaca compartment block without the use of a nerve stimulator. In both groups, a 5-mg/kg bolus of 0.5% ropivacaine was administered followed by continuous infusion of 0.1 mL/kg/h of 0.2% ropivacaine for 48 hours. In the postoperative period, all the patients received parenteral propacetamol (6 g daily) and ketoprofen (200 mg daily) and 0.1 mg/kg of subcutaneous morphine as rescue analgesia if the visual analog scale (VAS) pain values were greater than 30 mm. We evaluated the technical difficulties relative to catheter placement, the location of the catheter, the analgesic efficacy, and the distribution of the sensory block at 1 hour, 24 hours, and 48 hours. RESULTS: Catheter placement was faster in group 2, and the absence of nerve stimulation decreased material costs (P <.05). No significant difference was observed between groups concerning location of the catheter tip under the fascia iliaca. In both groups, the distribution of the sensory block and its course were similar except for those of the obturator nerve (more sensory blocks in group 1, P <.05). No significant difference was noted between the groups regarding median VAS pain values and consumption of morphine during the 48-hour period. No major side effect was observed. CONCLUSIONS: The authors conclude that a catheter for continuous lumbar plexus block can be placed more quickly and at lesser cost using the fascia iliaca technique than the perivascular technique with equivalent postoperative analgesic efficacy.