الفهرس | Only 14 pages are availabe for public view |
Abstract Different regional anaesthesia techniques have been implemented to decrease postoperative pain following total hip arthroplasty (THA). The fascia iliaca block (FIB) is used to block the lateral femoral cutaneous nerve (LFCN). The LFCN is traditionally blocked below the inguinal ligament by both regional anaesthesiologists and chronic pain specialists or damaged below the inguinal ligament by surgeons attempting anterior approaches in hip surgery. Many adjuvants like epinephrine, clonidine, opioids, ketamine, and midazolam were combined with local anaesthetics to prolong the duration of analgesia from nerve blocks but have met with limited success. However, the glucocorticoid dexamethasone has been shown to be effective in a small number of preclinical and clinical studies. Magnesium (Mg), the fourth most abundant cation in the body and the second most abundant intracellular cation, considered as a physiological blocker of N-methyl-D-aspartate (NMDA) receptors. Magnesium (Mg) has anti nociceptive effects due to its antagonistic effect of NMDA receptors. In its inactive state, the NMDA receptor is blocked by the presence of a centrally positioned magnesium ion, the afferent activity in nociceptor fibers dislodges the central magnesium ion from the NMDA receptor, therefore allowing calcium influx into the cells. The mechanism of this technique involves injecting local anaesthetic under the iliaca fascia where the femoral, lateral femoral cutaneous nerves, and some of the branches of the obturator nerve lie. The fascia iliaca block is dependent upon a sufficient spread of local anaesthetic along a connective tissue place to penetrate under the iliaca fascia to block these nerves. |