Surgeon-performed iliac fascia catheter versus epidural analgesia versus no regional analgesia after anterior acetabular fracture surgery: A retrospective comparative study of 85 patients.

Abstract

Perioperative analgesia after acetabular fracture surgery remains difficult. During anterior approaches, the surgeon can place a catheter against the femoral nerve through the ilioinguinal approach, or beneath the psoas muscle during the modified Stoppa approach, without any additional procedure. This technique has never been described. We evaluated the analgesic efficacy of this surgical iliac fascia block in acetabular fracture surgery (SIFBAF) after isolated anterior acetabular fracture surgery. We retrospectively included all adults who underwent isolated anterior acetabular fracture repair through an ilioinguinal, pararectus or modified Stoppa approach at a single centre between June 2022 and April 2025. Cumulative morphine consumption over the first three postoperative days was compared between three groups: SIFBAF, epidural analgesia, and no regional analgesia. Daily morphine consumption and visual analogue scale (VAS) scores were analysed with mixed models. Adjusted and sensitivity analyses were also performed. Eighty-five of 121 eligible patients were analysed (SIFBAF, n = 31; epidural, n = 30; no regional analgesia, n = 24). Median cumulative morphine consumption was 5.0 mg [0.42-10.5], 6.0 mg [1.67-12.2] and 12.7 mg [3.75-30.2] respectively (p = 0.123). In a mixed negative binomial model, daily consumption was lower with SIFBAF (IRR 0.49, 95% CI 0.19-1.25) and with epidural analgesia (IRR 0.49, 95% CI 0.19-1.26) than without regional analgesia, but the effect of group was not significant (p = 0.237). Consumption fell steeply over time in all groups (p < 0.001). Adjustment and three sensitivity analyses left these results unchanged. VAS scores stayed below 3 out of 10 and did not differ between groups. Catheters were still in place at day 3 in 64.5% of the SIFBAF group and 43.3% of the epidural group (p = 0.126). SIFBAF did not significantly reduce opioid consumption. It is nevertheless simple to place, fits into the anterior acetabular approach, and gave opioid consumption and pain scores that did not differ significantly from those obtained with epidural analgesia. These findings are hypothesis-generating and support a future randomised trial. Level III, retrospective comparative therapeutic study. REPORTING GUIDELINE: the study is reported according to the STROBE statement. The completed checklist is submitted as a separate file.