Injury - 2026-09-09 - Journal Article
Surgeon-performed iliac fascia catheter versus epidural analgesia versus no regional analgesia after anterior acetabular fracture surgery: A retrospective comparative study of 85 patients.
Bouffier V, Grèze J, Villaret C, Veloso M, Sanchez C, Boudissa M, Bouzat P
Topics
Key Takeaway
Surgeon-placed iliac fascia catheters (SIFBAF) reduced median 3-day morphine consumption to 5.0 mg versus 12.7 mg without regional analgesia, but this difference was not statistically significant (p=0.123).
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Summary
This single-center retrospective study compared cumulative 3-day morphine consumption and VAS scores among patients undergoing isolated anterior acetabular ORIF (ilioinguinal, pararectus, or modified Stoppa) randomized to SIFBAF (n=31), epidural (n=30), or no regional analgesia (n=24). Median morphine consumption was 5.0 mg, 6.0 mg, and 12.7 mg respectively, but group differences were non-significant (p=0.123); mixed negative binomial modeling showed SIFBAF and epidural both yielded IRR 0.49 versus no regional analgesia (95% CI 0.19–1.25 and 0.19–1.26), also non-significant (p=0.237). VAS scores remained below 3/10 across all groups with no between-group difference, and catheter retention at day 3 was 64.5% for SIFBAF versus 43.3% for epidural (p=0.126).
Key Limitation
The study is critically underpowered—85 patients across three groups with wide interquartile ranges in morphine consumption preclude detection of a clinically meaningful difference, rendering all null findings inconclusive.
Original Abstract
PURPOSE
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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 OF EVIDENCE
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.