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BackgroundPatients with hip fracture often experience severe pain, particularly during movement or slight positional change, prior to the occurrence of surgery. It is essential to explore the appropriate analgesic methods before surgery in patients with hip fracture, especially those capable of alleviating dynamic pain. Pericapsular nerve group (PENG) block was introduced as a useful technique for hip analgesia. In this study, we aimed to compare the reduction in dynamic pain between the PENG block and supra-inguinal fascia iliaca compartment block (SIFICB).MethodsThis prospective trial included 80 hip fracture patients aged ≥19 years, with an American Society of Anesthesiologists Physical Status of 1–4 and a baseline dynamic pain score ≥4 on the numerical rating scale. The patients were randomly allocated into the PENG block (n=40) and SIFICB group (n=40). For the PENG block and SIFICB, 20 mL and 30 mL of 0.3% ropivacaine was used, respectively. The primary outcome was reduction in dynamic pain scores at 30 min following the peripheral nerve block. Dynamic pain score was evaluated when the leg was passively raised.ResultsA total of 79 patients were included in the final analysis, and the reductions in pain score during hip flexion were 3.1±2.4 and 2.9±2.5 in the PENG block and SIFICB groups, respectively, which was statistically insignificant (p=0.75). Moreover, no significant differences were observed in any of the outcomes.ConclusionsPENG block and SIFICB could effectively provide analgesia for dynamic pain in patients with hip fractures, with no significant difference between the two groups.Trial registration number NCT04677348.

Cesarean Delivery (CD) is a commonly performed obstetric procedure. Adding a regional anesthesia technique to multimodal analgesia in CD, may improve the quality of postoperative analgesia. In this study we evaluated the efficacy of Transversalis Fascia Plane Block (TFPB) for postoperative analgesia management in CD. Blinded, prospective, randomized study. Postoperative recovery room & ward, tertiary university hospital, Istanbul, Turkey, Seventy-five patients (ASA II-III) scheduled to undergo Cesarean delivery were recruited. Following exclusion, 70 patients were randomized into two equal groups (block and control group). Standard multimodal analgesia (routine paracetamol and tramadol PCA in addition to diclophenac sodium as rescue analgesia) was performed in Group C while TFPB block was also performed in the intervention (TFPB) group. The primary outcome was tramadol consumption within the first 24 h. The secondary outcome was Numeric Rating Scale (NRS) scores during rest and movement/coughing. Tramadol consumption in the first 24 h was 175 ± 72.32 mg in the control and 101.42 ± 51.45 mg in the TFPB group (p < 0.05). NRS was lower in Group TFPB during the first 3 h and at the 12th hour. There was no difference in NRS scores at other hours. Bilateral ultrasound guided TFPB leads to effective analgesia and a decrease in analgesia requirement in first 24 h in patients undergoing CD. •Transversalis fascia plane block (TFPB) is a known block but there are limited studies evaluating effects of TFPB.•When added to multimodal analgesia, TFPB reduces analgesic requirement in Cesarean Delivery patients.•TFPB is an easy and safe technique.

Background The duration of a single fascia iliaca compartment block (FICB) with ropivacaine is limited. This study investigated whether methylene blue as an adjuvant anesthetic in FICB can enhance the postoperative analgesic effect following total hip arthroplasty (THA). Methods Patients who planned to undergo THA were recruited for this randomized clinical trial from June 2023 to February 2024. Ninety elderly patients undergoing THA were randomly divided into two groups that received ultrasound-guided FICB with either ropivacaine and methylene blue (MB + R group, n  = 45) or ropivacaine only (R group, n  = 45) before induction of general anesthesia. The primary outcomes were postoperative Visual Analog Scale (VAS) scores. Secondary outcomes included inflammatory factor levels, heart rate (HR), mean arterial pressure (MAP), postoperative analgesic use, postoperative activity, and adverse events. Results The MB + R group had significantly lower VAS scores at both rest and with activity at 24 and 48 h postoperatively than the R group ( P  < 0.001). Additionally, the hypersensitive C-reactive protein, procalcitonin, and neutrophil-to-lymphocyte ratio values were significantly lower in the MB + R group than in the R group on the first and second days after surgery ( P  < 0.05). The number of patients requiring supplemental analgesia postoperatively was significantly lower in the MB + R group ( P  = 0.020). Additionally, the MB + R group had a significantly longer walking distance on the first time out of bed and a higher number of out-of-bed activities within 48 h postoperatively ( P  < 0.001). Conclusion Compared to ropivacaine alone, the combination of ropivacaine and methylene blue in FICB provided better analgesic effects over a longer duration. Additionally, the addition of methylene blue reduced the postoperative production of inflammatory markers and promoted patients’ functional recovery. Trial registration ClinicalTrials.gov, Registration number: NCT06284941, Retrospectively registered, Date of registration: February 04, 2024.

In recent years, the interest in the comprehension of the fasciae has significantly grown, together with the necessity of finding a consensus for a terminology of the fasciae in the research and clinical fields. Furthermore, it is becoming necessary to categorize the various types of fascia (superficial, deep, visceral, neural) since they possess different anatomical characteristics, and are implicated in different pathophysiological pathways. While in the past we have described the deep/muscular fascia, the aim of this work is to summarize and catalog the information relating to the human superficial fascia (thickness, cellular end extracellular matrix component, innervation, vascularization).

The aim of this study was to compare the analgesic efficacy of the ultrasound-guided block of femoral nerve or fascia iliaca compartment in patients who underwent patella fracture surgery. Fifty patients were blinded and randomized into groups treated with continuous fascia iliaca compartment block (CFICB) ( n  = 25) or continuous femoral nerve block (CFNB) ( n  = 25) after patella fracture surgery. Analgesic effects of the two methods were assessed and compared. Patients from the two groups showed no significant difference in visible analog scales at rest and during movement, fentanyl consumption, nausea, and vomiting. The time of catheter insertion was significantly shorter in carrying out CFICB compared to that in performing CFNB (8.3 ± 1.4 vs 14.5 ± 3.0 min). Three of the 25 patients in CFNB group experienced dysesthesia of anterior of the thigh, a complication which was not observed in CFICB-treated patients. CFICB and CFNB were equally effective in relieving pain after the patella fracture surgery. However, compared to CFNB, CFICB was found to be safer and easier to perform.

Complex Regional Pain Syndrome (CRPS) is a debilitating pain disorder involving chronic inflammation, neural sensitization and autonomic dysfunction. Fascia, a highly innervated connective tissue, is increasingly recognized for its role in pain modulation, yet its contribution to CRPS remains underexplored. This narrative review synthesizes the current evidence on fascia’s involvement in CRPS pathophysiology and potential therapeutic strategies. A literature search was conducted in PubMed, Scopus and Web of Science, selecting studies on fascia, CRPS, inflammation, oxidative stress and autonomic dysfunction, with emphasis on recent experimental, anatomical and clinical research. Fascia contributes to CRPS through neuroinflammation, fibrosis and autonomic dysregulation. Its rich innervation facilitates peripheral and central sensitization, while inflammatory mediators drive fibrosis, reducing elasticity and exacerbating pain. Autonomic dysfunction worsens hypoxia and oxidative stress, fueling chronic dysfunction. Advances in sonoelastography provide new insights, while fascial manipulation and targeted therapies show promise in early studies. Fascia plays a key role in CRPS pathophysiology, yet its clinical relevance remains underexplored. Future research integrating imaging, molecular profiling and clinical trials is needed to develop evidence-based fascia-targeted interventions, potentially improving CRPS diagnosis and treatment.

Currently three types of regional nerve blocks are commonly administered to provide analgesia to patients with hip fractures; the Fascia-Iliaca Compartment Block (FICB), Femoral Nerve Block (FNB) and Pericapsular Nerve Group Block (PENG). It is unclear which of these provides the best analgesia and the lowest number of complications. This systematic review aims to evaluate the literature concerning the efficacy and safety of pre-operatively placed PENG block compared to FICB and FNB for hip fractures. The PRISMA statement guidelines were used and a systematic search of MEDLINE (via Ovid), Embase, Web of Science and Google Scholar was performed until April 8th, 2024. Out of 118 identified studies, 17 (14 RCTs, 3 observational) met the inclusion criteria, of which 5 exhibited a low risk of bias. Pain scores were significantly lower with the PENG block compared to FICB/FNB in 12 of 17 studies, while 5 reported no difference. Opioid use was lower in 4 of 11 studies favoring PENG, while the other 7 showed no differences with FICB/FNB. Patient satisfaction was found to be higher in PENG in 5 studies, while 2 other reported no difference. Ease of spinal positioning was better with PENG in 4 studies, with 3 reporting no difference. Adverse events showed no significant differences between blocks. None of the studies found FNB or FICB to be favorable on any of these outcomes. PENG block may be a promising technique to provide analgesia to patients with hip fractures. However, there was significant heterogeneity in endpoints used and in outcomes of the various studies that compared PENG with FNB or FICB blocks. Also, only one study was conducted in the emergency department (ED). Larger randomized controlled trials with patient-centred outcomes in the ED-setting are required to definitively establish which nerve block is most effective. •PENG is a promising technique to provide analgesia to patients with a hip fracture.•Larger randomized controlled trials should establish which block is most effective.•Future studies should focus on patient-centred outcomes in the ED-setting to definitively establish which nerve block is most effective.

To enable selection of a safer suspension site to use in face and neck lifting procedures, the spatial relationship between the tympanoparotid fascia and the great auricular nerve should be clarified. In this study, we aimed to elucidate the position of the tympanoparotid fascia and the pathway of the lobular branch of the great auricular nerve traversing the tympanoparotid fascia. Twenty hemifaces from non-preserved bequeathed Korean cadavers (5 males, 7 females; mean age, 77.0 years) were dissected to determine the great auricular nerve distribution close to the tympanoparotid fascia of clinical significance for face and neck lift procedures. We observed the tympanoparotid fascia in all specimens (20 hemifaces). The tympanoparotid fascia was located anteriorly between the tragus and intertragic notch. Regarding the spatial relationship between the tympanoparotid fascia and the great auricular nerve, we found the sensory nerve entering the tympanoparotid fascia in all specimens (100%), and the depth from the skin was approximately 4.5 mm; in 65% of the specimens, the lobular branch was found to run close to the tympanoparotid fascia before going into the earlobe. Provided with relatively safer surface mapping to access the tympanoparotid fascia free of the lobular branch of the great auricular nerve, surgeons may better protect the lobular branch by anchoring the SMAS-platysma flap and thread to the deeper superior and anterior portions of the expected tympanoparotid fascia.

Pain management for hip and proximal femoral fractures includes oral and parenteral opioids and various regional anesthesia techniques. Fascia iliaca compartment blocks (FICB) are commonly used for these patients. At present, a unified view of the analgesic effect of FICB has not been reached. In addition, the comparison between single shot FICB and continuous FICB has not elicited clear evidence-based results. We will compare the efficacy and safety of systemic analgesics, single shot or continuous FICB in the pain management, complication prevention and satisfaction, in our systematic review and network meta-analysis. China National Knowledge Infrastructure, Chinese Biomedical Literatures database, PubMed, the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, EMBASE, and Web of Science will be searched until June 2023. Two authors will independently screen the studies for eligibility and perform data extraction. The Cochrane risk of bias tool (RoB 2) will be used to assess the quality of evidence. We will use the GRADE approach to assess the certainty of the evidence across studies included in this review. All the statistical analyses will be conducted using Rev Man 5.3, WinBUGS 1.4.3, and Stata 13. Our review involves a secondary analysis of existing published studies, therefore there is no need for formal research ethics approval. We will disseminate our findings through publication in a peer-reviewed journal. PROSPERO, CRD42023425282.

This randomized controlled single blinded clinical trial compared the fascia iliaca block (FIB) and the lumbar plexus block (LPB) in patients with moderate to severe pain following hip arthroscopic surgery. Single blinded randomized trial. Postoperative recovery area, postoperative days 0 and 1. Fifty patients undergoing hip arthroscopy were approached in the Post Anesthesia Care Unit (PACU) if they had moderate to severe pain (defined as > or equal 4/10 on the numeric rating scale). Twenty-five patients were allocated to the FIB and twenty-five patients to the LPB. Fascia iliaca block or lumbar plexus block. A blinded observer recorded pain scores just prior to the block, 15 min following the block (primary endpoint), and then every 15 min for 2 h (or until the patient was discharged). Total PACU time and opioid use were recorded. Pain scores and analgesic use on postoperative day (POD) 0, and POD 1 were recorded. At 24 h post block the Quality of Recovery 9 questionnaire was administered. The mean pre-block pain scores were comparable between the two groups (P = 0.689). There was no difference in mean post block pain scores between the two groups at 15 min (P = 0.054). In the PACU patients who underwent a LPB consumed less opioids compared to FIB patients (P = 0.02), however no differences were noted between the two groups in PACU length of stay, or POD 0 or 1 opioid use. A fascia iliaca block is not inferior to a lumbar plexus block in reducing PACU pain scores in patients with moderate to severe pain following hip arthroscopic surgery and is a viable option to help manage postoperative pain following hip arthroscopic surgery. •Hip arthroscopic surgery (HAS) is a commonly performed and painful outpatient procedure.•The ideal way to manage postoperative pain has not been elucidated.•Innervation to the hip is complex making compartment blocks that block multiple nerves enticing.•The fascia iliaca block is an excellent choice to help provide analgesia following HAS.