COMPARISON OF THE 3-IN-ONE AND FASCIA ILIACA COMPARTMENT BLOCKS IN ADULTS - CLINICAL AND RADIOGRAPHIC ANALYSIS

The 3-in-1 (Group 1) and fascia iliaca compartment (Group 2) blocks, h vo single-injection, anterior approach procedures used to simultaneous ly block the femoral, obturator, and lateral femoral cutaneous (LFC) n erves, were compared in 100 adults after lower limb surgery. Pain cont rol, sensory and motor blockades, and radiographically visualized spre ad of local anesthetic solution were studied prospectively. Both appro aches provided efficient pain control using 30 mL of 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine and 5 mL of contrast media (iopamidol). Complete lumbar plexus blockade was achieved in 18 (38%) Group 1 and 17 (34%) Group 2 patients (n = 50 patients per group). Se nsory block of the femoral, obturator, genitofemoral, and LFC nerves w as obtained in 90% and 88%, 52% and 38%, 38% and 34%, and 62% and 90% of the patients in Groups 1 and 2, respectively (P < 0.05). Sensory LF C blockade was obtained more rapidly for the patients in Group 2 (P < 0.05). Concurrent internal and external spread of the local anesthetic solution under the fascia iliaca and between the iliacus and psoas mu scles was noted in 62 of the 92 block procedures analyzed radiographic ally. Isolated external spreads under the fascia iliaca and over the i liacus muscle were noted in 10% and 36% of the patients in Groups 1 an d 2, respectively (P < 0.05). The local anesthetic solution reached th e lumbar plexus in only five radiographs. We conclude that the fascia iliaca compartment block is more effective than the 3-in-1 block in pr oducing simultaneous blockade of the LFC and femoral nerves in adults. After both procedures, blockade was obtained primarily by the spread of local anesthetic under the fascia iliaca and only rarely by contact with the lumbar plexus. Implications: In adults, the two anterior app roaches, 3-in-1 and fascia iliaca compartment blocks, provide effectiv e postoperative analgesia. The fascia iliaca compartment technique pro vides faster and more consistent simultaneous blockade of the lateral femoral cutaneous and femoral nerves. Sensory block is caused by the s pread of local anesthetic solution under the fascia iliaca and only ra rely to the lumbar plexus.