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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy

Published on: January 31, 2025

Ultrasound-guided caudal block versus supra inguinal fascia iliac block for pain management in paediatric hip

Anuj Verma¹, Prem Raj Singh², Sateesh Verma²

¹Senior Resident, Departments of Anaesthesiology, KGMU, Lucknow, Uttar Pradesh, India.

Indian Journal of Anaesthesia

|February 16, 2026

Abstract

Background And Aims:

Regional anaesthetic techniques are widely used for postoperative analgesia in paediatric hip and femur surgeries. Caudal blocks, while effective, require precise anatomical knowledge and can be time-consuming with potential complications. The suprainguinal fascia iliaca block (FICB) offers a potentially simpler and safer alternative. This study aimed to compare the analgesic efficacy of ultrasound guided caudal block and suprainguinal FICB in children undergoing hip surgery.

Methods:

This randomised, double-blind study included 60 paediatric patients aged 2-8 years undergoing unilateral hip surgery. Participants were assigned to either Group A (caudal block) or Group B (suprainguinal FICB). The primary outcome of this study was to compare the postoperative pain intensity using the FLACC (Face, Legs, Activity, Cry, Consolability) scale assessed at 4 h postoperatively. The secondary outcomes were to assess pain scores at additional time intervals (30 minutes, 2, 6, 12, and 24 h), evaluate the time first to rescue analgesia, and compare the total number of analgesic doses administered within the first 24 h postoperatively. Data were analysed using SPSS Version 22.0 and compared using Student's independent samples t-test.

Results:

At 4 h postoperatively, FLACC scores were comparable between both groups (P > 0.05), indicating no significant difference in peak pain intensity. FLACC scores at additional time intervals (30 minutes, 2, 6, 12, and 24 h) were also statistically similar. However, the time to first rescue analgesic was significantly longer in Group B (14.3 h) than in Group A (10.0 h; P = 0.043), suggesting more prolonged analgesia in the FICB group. Although not statistically significant, the average number of rescue doses was slightly higher in Group A (2.32) compared to Group B (2.00).

Conclusion:

Suprainguinal FICB provides analgesia comparable to caudal block, with a longer duration before requiring rescue analgesia.

Keywords:

Anaesthesia analgesia caudal block congenital hip dislocation nerve block pain postoperative suprainguinal fascia iliaca block ultrasonography

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