DOI: https://doi.org/10.14710/jai.v0i0.66116

Fascia Iliaca Compartment Block as Pain Management for Postoperative Femur Fracture in the Elderly: A Case Report

Department of Anesthesiology and Intensive Therapy, Prof. dr. Soeharso Orthopaedic Hospital, Sukoharjo, Indonesia, Indonesia

Received: 21 Aug 2024; Published: 21 Aug 2025.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Background:

Femur fracture has highest incidence in geriatric patients. In the geriatric population, special attention is required regarding medications used for anesthesia and analgesia in the perioperative period. Failure in pain management will increase the neurohormonal stress response, making pain control critically important. Minimal use of opioids in geriatric patients can help avoid side effects and complications. The fascia iliaca compartment block (FICB) is a safe and efficient method of nerve block. FICB has been reported to reduce opioid requirements in hip surgery and is expected to improve mobilization speed, ambulation, and reduce PONV, DVT, and pneumonia.

Case:

A 71-year-old female with a closed right intertrochanteric femur fracture was planned for open reduction and internal fixation (ORIF) with a proximal femoral nail antirotation (PFNA). The patient was classified as ASA II, geriatric, with stage I hypertension. Preoperative vital signs showed a blood pressure of 170/95, heart rate of 65, respiration rate of 20, and SpO2 of 98% with nasal cannula oxygen at 3 L/min. Spinal anesthesia was administered at the L3-L4 level. FICB was performed postoperatively. Pain assessment using the NRS, rescue analgesic use, and PONV were evaluated post-surgery. In this geriatric patient, monitoring was conducted at 6 hours (T1), 24 hours (T2), 48 hours (T3), and 48 hours (T4) postoperatively. The results showed that the Visual Analog Scale (VAS) scores consistently remained between 1-2, no PONV symptoms were observed, and no rescue analgesics were required during T1-T4.

Discussion:

Pain management in PFNA with regional FICB anesthesia can simultaneously block the femoral nerve (FN), obturator nerve (ON), and lateral femoral cutaneous nerve (LCFN). Thus minimizing systemic symptoms compared to analgesics administered intravenously. In this case, the administration of 30 cc levobupivacaine via FICB provided effective analgesia for up to 72 hours post-blockade in a geriatric patient without causing side effects such as PONV.

Conclusion:

Postoperative FICB for hip surgery in geriatric patients provides effective analgesia with minimal side effects

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Keywords: anesthesia; block; compartment; fascia; hip; iliaca; surgery

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Section: Case Reports
Language : EN
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  4. Helander EM, Webb MP, Menard B, Prabhakar A, Helmstetter J, Cornett EM, et al. Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery. Curr Pain Headache Rep. 2019 May;23(5):33
  5. Dubljanin-Raspopovic E, Markovic-Denic L, Zivkovic K, Nedeljkovic U, Tomanovic S, Kadija M, et al. The impact of postoperative pain on early ambulation after hip fracture. Acta Chir Iugosl. 2013;60(1):61–4
  6. Perlas A, Kirkham KR, Billing R, Tse C, Brull R, Gandhi R, et al. The Impact of Analgesic Modality on Early Ambulation Following Total Knee Arthroplasty: Reg Anesth Pain Med. 2013;38(4):334–9
  7. Dufort A, Samaan Z. Problematic Opioid Use Among Older Adults: Epidemiology, Adverse Outcomes and Treatment Considerations. Drugs Aging. 2021 Dec;38(12):1043–53
  8. Malec M, Shega JW. Pain Management in the Elderly. Med Clin North Am. 2015 Mar;99(2):337–50
  9. Desmet M, Balocco AL, Van Belleghem V. Fascia iliaca compartment blocks: Different techniques and review of the literature. Best Pract Res Clin Anaesthesiol. 2019 Mar;33(1):57–66
  10. Gola W, Bialka S, Owczarek AJ, Misiolek H. Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study. Int J Environ Res Public Health. 2021 May 4;18(9):4891
  11. Ståhl A, Westerdahl E. Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery—A Quasi-experimental Study. Clin Interv Aging. 2020 Oct;Volume 15:1821–9
  12. Chandran R, Beh Z, Tsai F, Kuruppu S, Lim J. Peripheral nerve blocks for above knee amputation in high-risk patients. J Anaesthesiol Clin Pharmacol. 2018;34(4):458
  13. O’Reilly N, Desmet M, Kearns R. Fascia iliaca compartment block. BJA Educ. 2019 Jun;19(6):191–7
  14. Tarekegn F, Sisay A. A review of evidence-based clinical practice on fascia iliaca compartment block for lower limb injury. Ann Med Surg [Internet]. 2021 Sep [cited 2024 Aug 17];69. Available from: https://journals.lww.com/10.1016/j.amsu.2021.102758
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  16. Al Harbi M, Alshaghroud S, Aljahdali M, Ghorab F, Baba F, Al Dosary R, et al. Regional anesthesia for geriatric population. Saudi J Anaesth. 2023;17(4):523

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