Continuous Suprainguinal Fascia Iliaca Block vs Epidural Analgesia for Pediatric Hip Surgery: A Retrospective Cohort Study

Lloyd M Halpern,1 Zackary Correll,2 De-An Zhang,3 Clark J Kogan,4 Kirk A Ryan,5 Ted Sousa6 1Department of Anesthesia, Shriners Children’s Hospital, Spokane, WA, USA; 2Department of Medicine, University of Washington School of Medicine, Spokane, WA, USA; 3Department of Anesthesia, Shriners Children’s Hospital, Pasadena, CA, USA; 4Department of Statistics, Washington State University, Spokane, WA, USA; 5Department of Data Analysis, Shriners Children’s Hospital, Spokane, WA, USA; 6Department of Orthopedic Surgery, Shriners Children’s, Spokane, WA, USACorrespondence: Lloyd M Halpern, Email lhalpern@shrinenet.orgIntroduction: The primary aim of this study was to compare the continuous suprainguinal fascia iliaca block (CSFI) and continuous epidural analgesia (CEA) for procedures of the proximal femur and acetabulum in children. We hypothesized that CSFI would provide equivalent opioid requirements while both blocks were in place, reduced opioid requirements after epidural removal, earlier mobilization, and decreased length of stay compared to CEA.Materials and Methods: We retrospectively examined all pediatric patients who underwent a procedure of the proximal femur or acetabulum between January 1, 2013, and December 31, 2023. Outcome measures included opioid usage, verbal pain scores (0-10), sedation scores, time to ambulation and length of hospital stay. The primary endpoint was daily opioid requirements.Results: There were 82 patients in the cohort, 35 patients in the CEA group and 47 patients in the CSFI group. We found no evidence for differences in daily mean opioid requirements (parenteral and oral) for the two groups on the day of surgery (DOS) and POD 1 when both blocks were in place. CSFI was strongly associated with lower mean opioid requirements on POD 2 and POD 3 following removal of the epidural catheter, earlier time to ambulation, shorter length of stay and less sedation on the DOS, POD 1, and 2. Four patients reported persistent anterior thigh numbness 6 weeks after the procedure, all in the CSFI group. (8.5%).Conclusion: CSFI was associated with similar parenteral and oral opioid requirements compared to CEA while both blocks were in place, earlier mobilization, reduced length of stay, less sedation and reduced opioid usage after epidural removal. CSFI appears to offer significant advantages over CEA for procedures of the proximal femur and acetabulum in pediatric patients, but persistent thigh numbness in the CSFI group warrants further investigation.Keywords: fascia iliaca block, epidural anesthesia, hip surgery, regional anesthesia