الفهرس 
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Abstract
Patients undergoing total hip and knee arthroplasty experience substantial and sustained postoperative pain. Inadequate analgesia may impede physical therapy and rehabilitative efforts and delay hospital dismissal. Traditionally, postoperative analgesia after total joint replacement was provided by either intravenous patient-controlled analgesia or epidural analgesia. Each, however, had disadvantages as well as advantages. Peripheral nerve blockade of the lumbosacral plexus has emerged as an alternative analgesic approach. In several studies, unilateral peripheral block provided a quality of analgesia and functional outcomes similar to those of continuous epidural analgesia and superior to those of systemic analgesia, but with fewer side effects because of their opioid-sparing properties. Peripheral nerve block techniques may be the optimal analgesic method following total joint arthroplasty.
FICB is a peripheral nerve block, which has become an important part of post-operative analgesic strategies.it is now one of the major methods of lower limb nerve block and is widely used in postoperative analgesia in patients after lower limb surgery. More specifically, the femoral, lateral femoral cutaneous, and obturator nerves of the thigh are blocked by local anesthetic (LA) injected under the fascia of iliacus muscle. The pain block can persist up to 24 h. However, the pop technique using fascial click had a low success rate of 35%–47%.When FICB was performed under real-time ultrasound guidance, the success rate increased to 82%–87%, which led to an increased interest in FICB as a postoperative analgesia option for hip and knee surgeries.
Also one of the most common peripheral nerve blocks to facilitate postoperative analgesia is the 3-in-1 nerve block, which uses a single injection to block the femoral, lateral femoral cutaneous (LFC), and obturator nerves. These 3 nerves provide the major sensation to the lower extremity, and the ability to inhibit the individual distributions allows for successful analgesia and anesthesia during, and following, knee and hip surgery. Bedside US has rapidly become integrated in the practice of nerve blocks and is already used as a safer approach to other landmark-guided techniques. In the operative setting, the femoral nerve block is most often conducted using a nerve stimulator. However, nerve stimulator technique requires additional costs and specialized training. In addition, anesthesiology research suggests that US-guided femoral nerve blocks may be superior to nerve stimulator–guided nerve blocks in regard to onset of action and amount of anesthetic required.
In this study, we aimed to compare postoperative analgesia between ultrasounded guided FICB and three in one nerve block. the study was conducted on 80 randomly chosen patients from 21 to 65 years old in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 40 patients group I and group II.
After preoperative assessment and obtaining baseline vital data, all patients received spinal anesthesia. Patients in the group I received received FICB (35-40 ml of 0.25% bupivacaine).Patients in the group II received three in one bock (35-40 mL of bupivaccaine 0.25%).
The two groups were adequately monitored and assessed post-operatively and they were compared regarding demographic data, haemodynamics, postoperative pain control using Visual Analogue Scale at rest and at movement through different time intervals, Mean requirement of supplemental analgesic (Diclofenac Sodium 1.5 mg/kg IV), Sensory blockade of Femoral, Obturator, LFC, Genitofemoral nerves and motor blockade of femoral and obturator nerves.
In this study, both FICB and three in one block provided good quality of postoperative analgesia and patient satisfaction as evidenced by low VAS and low postoperative rescue analgesic requirements. We observed that both techniques provided equal sensory blockage of femoral nerve, obturator nerve and genitofemoral nerve, but sensory blockage of LFC nerve was demonstrated in 92.5% patients in FICB and 62.5% patient in three in one block, which was significantly higher (p-value <0.001 HS). This sensory blockage of LFC nerve is important because the sparing of LFC nerve may at least, be responsible for pain in incisional area after hip surgery.