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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