51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Suprainguinal Fascia Iliaca Catheter for Above Knee Amputation: A Case Report

Introduction:

•Above Knee Amputation (AKA) à incidence of acute and chronic pain (5):

•Regional anesthesia à risk (4,5)

•Chronic pain à 6.4% with GA; 2.8% with RA (2)

•Acute pain à RA opioids by 40% in first 72 hours (1)

•The fascia iliaca compartment block (FICB) targets (3):

•Femoral nerve

•Obturator nerve

•Lateral femoral cutaneous nerve

•Continuous FICB has not been studied in lower extremity amputation.

•We present two cases in which suprainguinal FICB catheters were used for analgesia following AKA.

Materials and Methods:

•IRB review was not required for case-report per institution policy.

•A linear ultrasound probe used to identify the internal oblique (IO) muscle, sartorius muscle, and deep circumflex iliac arteries in the sagittal position.

•A 17-gauge tuohy needle was advanced from caudad to cephalad in-plane.

•20mL of 0.25% ropivacaine was deposited at the junction of the IO and sartorius muscles, but above the iliacus muscle.

•A catheter was threaded in this area.

•Blocks assessed prior to surgery consistent with blockade of the:

•Femoral nerve

•Obturator nerve

•Lateral femoral cutaneous nerve

Case Report:

Patient 1:

•37-year-old female with Ewing sarcoma:

•Chronic opioid use (morphine ER 15 mg TID, oxycodone 10 mg Q6h)

•Underwent left AKA

•Preoperative placement:

•Left suprainguinal FICB catheter

•Left subgluteal sciatic catheter

•Infusion: 0.2% ropivacaine at 6 mL/hr (2 mL bolus q15 min).

•

•Outcome:

•Minimal pain POD0.

•POD1: FICB removed due to leakage around insertion site.

•Developed severe anterior/medial thigh pain (9–10/10).

Patient 2:

•72-year-old male with dementia, prior stroke, and end-stage renal disease on intermittent hemodialysis:

•Underwent right AKA

•Preoperative placement:

•Right suprainguinal FICB catheter

•Anterior sciatic catheter (limited patient cooperation)

•Infusion: 0.2% ropivacaine at 6 mL/hr (2 mL bolus q15 min).

•

•Outcome:

•Pain assessment limited due to cognitive impairment.

•Appeared comfortable at rest postoperatively.

•On POD2, both catheters were removed by the patient.

•Transitioned to multimodal systemic analgesia.

Discussion:

•Continuous suprainguinal FICB may provide reliable medial and anterior thigh analgesia in AKA patients while avoiding risks associated with lumbar plexus catheters.

•Advantages compared to lumbar plexus catheters (4):

•Avoidance of neuraxial-level anticoagulation considerations

•Easier patient positioning

• risk of epidural spread

•Compared to femoral nerve blocks:

•Medial and lateral thigh sensory coverage

•In Patient 1, removal of the FICB catheter resulted in severe anterior/medial thigh pain:

•Suggests meaningful analgesic contribution

•Catheter securement remains an important limitation, as premature removal occurred in both patients.

Limitations

•Small sample size.

•Premature catheter removal.

•Patient cooperation.

Future directions

•Prospective comparison with femoral and lumbar plexus nerve catheters.

•Assessment of opioid consumption and long-term outcomes.

•Optimization of catheter securement techniques.

Referances:

1. Ayling OGS, Montbriand J, Jiang J, et al. Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation. Eur J Vasc Endovasc Surg. 2014;48(5):559-564. doi:10.1016/j.ejvs.2014.07.002

2. Cho HS, Kim S, Kim CS, Kim YJ, Lee JH, Leem JG. Effects of different anesthetic techniques on the incidence of phantom limb pain after limb amputation: a population-based retrospective cohort study. Korean J Pain. 2020;33(3):267-274. doi:10.3344/kjp.2020.33.3.267

3. Demir U, Taşkın Ö, Yılmaz A, et al. Continuous Suprainguinal Fascia Iliaca Block for Postoperative Analgesia Management After Hip and Knee Arthroplasty Surgeries: A Report of Two Cases. Cureus. 2025;17. doi:10.7759/cureus.77016

4. Desmet M, Balocco AL, Van Belleghem V. Fascia iliaca compartment blocks: Different techniques and review of the literature. Best Pract Res Clin Anaesthesiol. 2019;33(1):57-66. doi:10.1016/j.bpa.2019.03.004

5. Leal NTB, de Araújo NM, Silva S de O, et al. Pain management in the postoperative period of amputation surgeries: A scoping review. J Clin Nurs. 2023;32(21-22):7718-7729. doi:10.1111/jocn.16846

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Continuous Suprainguinal Fascia Iliaca Compartment Catheter for Postoperative Analgesia in Above Knee Amputation: A Case Report

Poster Presenter

Authors

Affiliations

Part of Topic