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

Lloyd M Halpern¹, Zackary Correll², De-An Zhang³

¹Department of Anesthesia, Shriners Children's Hospital, Spokane, WA, USA.

Local and Regional Anesthesia

|May 7, 2026

Insights

Continuous suprainguinal fascia iliaca block (CSFI) provided similar opioid needs as continuous epidural analgesia (CEA) initially. CSFI led to less pain medication, earlier movement, and shorter hospital stays in pediatric patients undergoing hip surgery.

Area of Science:

Pediatric Anesthesiology
Regional Anesthesia
Pain Management

Background:

Pediatric orthopedic surgery for proximal femur and acetabulum procedures often requires effective pain management.
Continuous epidural analgesia (CEA) is a common method, but alternatives are sought.

Purpose of the Study:

To compare continuous suprainguinal fascia iliaca block (CSFI) with CEA for pediatric proximal femur and acetabulum procedures.
To evaluate opioid requirements, pain scores, sedation, mobilization, and length of stay.

Main Methods:

Retrospective review of 82 pediatric patients undergoing proximal femur or acetabulum surgery.
Comparison of daily opioid requirements, pain, sedation, ambulation time, and hospital stay between CSFI and CEA groups.

Main Results:

No difference in opioid requirements when blocks were in place.
CSFI group showed reduced opioid use post-epidural removal, earlier ambulation, shorter hospital stay, and less sedation.
8.5% of CSFI patients experienced transient thigh numbness.

Conclusions:

CSFI offers advantages over CEA for pediatric hip surgery, including reduced opioid consumption post-removal, faster recovery, and shorter hospital stays.
Potential for persistent thigh numbness with CSFI requires further investigation.

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Abstract

Introduction:

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:

epidural anesthesia fascia iliaca block hip surgery regional anesthesia

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