Timing of suprainguinal fascia iliaca block in hip hemiarthroplasty: impact on QoR-15 scores- a prospective randomized study

Abstract

Background Suprainguinal Fascia Iliaca Compartment Block (SFICB) is a widely utilized technique for managing postoperative pain in hip surgery. The timing of its administration, either preoperative or postoperative, plays a crucial role in influencing patient outcomes. This study aims to compare the effects of preoperative versus postoperative SFICB on postoperative recovery in patients undergoing hip hemiarthroplasty (HHA). Methods In this prospective randomized trial, 60 patients scheduled for HHA were randomly assigned to two groups: Group PreS (preoperative SFICB) and Group PostS (postoperative SFICB). SFICB was performed under ultrasound guidance using 0.20% bupivacaine. The primary outcome was assessed using the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the Nursing Delirium Screening Scale (N-DSS), postoperative nausea/vomiting (PONV), and opioid consumption. Results Demographic variables were comparable between groups (p > 0.05). Spinal anesthesia duration was shorter in Group PreS (p = 0.005), while surgery and total procedure times were similar (p > 0.05). QoR-15 scores improved in both groups, with significant increases in moderate (p = 0.004, p = 0.047) and severe pain (p < 0.001, p = 0.028). At T1, total QoR-15 (p = 0.034) and severe pain score (p < 0.001) were significantly better in Group PreS. Preoperative fentanyl need was lower in Group PreS (p < 0.001). Although first rescue analgesia time was longer in Group PostS (p = 0.026) morphine equivalent consumption (p = 0.564) was similar. N-DSS, delirium incidence, and PONV showed no differences (p > 0.05). No complications were observed. Conclusions Preoperative SFICB improved postoperative QoR-15 scores compared to postoperative SFICB in elderly HHA patients, but optimal timing and perioperative settings require further research. Trial registration ClinicalTrials.gov (ID NCT05965544). The clinical trial was prospectively registered on July 20, 2023.