The Suprainguinal Fascia Iliaca Block Prolonging Spinal Anesthesia Duration

Spinal anesthesia is commonly used for lower limb procedures, its duration may be limited with potential complications due to high doses of local anesthetic. This study describes the technique and experience of using suprainguinal fascia iliaca block (SIFI) as an adjunct to spinal anesthesia in an elderly patient undergoing lower extremity surgery. The case presented here involves an 81-year-old female undergoing hip surgery, where a SIFI block was performed prior to the administration of spinal anesthesia. Despite the unexpectedly prolonged surgical duration of approximately 5 hours, the patient remained comfortable, and the surgery was completed without complications. Subarachnoid block for provision of surgical anesthesia generally lasts between 2 and 3 hours with dose-dependent local anesthetic-related adverse effects. This may hinder the utility of spinal anesthesia in complex cases where extended surgical duration may be expected. The continuous spinal anesthesia and combined spinal-epidural (CSE) are useful techniques to provide consistent peri-operative anesthesia with precise titration of anesthesia levels. However, this presents with a risk of accidental dural puncture with CSE, post-dural puncture headache, and inadvertent drug errors with a spinal or epidural catheter. The judicious use of other adjuvants alongside local anesthetics offers advantages in extending the duration of anesthesia by a modest increment. The integration of spinal anesthesia with SIFI is a promising strategy to extend block duration, reduce peri-operative opioid requirements, and enhance patient outcomes. Overall, SIFI is a safe anesthetic technique for the peri-operative management of hip fracture patients and may present synergistic effects when combined with spinal anesthesia and may prolong the duration of regional anesthesia during unexpectedly prolonged surgery.