What is it about?
Prospective Comparative Study of Efficacy of Bupivacaine Alone or in Combination with Dexamethasone
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Why is it important?
Context: Femur fractures patients are in considerable pain on attempted hip flexion. Fascia Iliaca Compartment Block (FICB) is an effective means of providing analgesia during transit and positioning for spinal anesthesia which also persists postoperatively. Aims: To assess the preoperative and postoperative analgesic effect of Dexamethasone as adjuvant to Bupivacaine in FICB. Settings and Design: After obtaining ethical committee clearance, minimum sample size calculated from pilot studies was 64. Between Dec 2016– Feb 2017, 70 patients with proximal femur fractures posted for open reduction and internal fixation surgery were recruited for the study. Methods and Materials: Patients were randomly distributed into Control and Test Groups 35 patients received USG guided FICB with 28 ml 0.25% Bupivacaine + 2 ml Normal Saline and remaining received block with 28 ml 0.25% Bupivacaine + 2 ml (8 mg) Dexamethasone 20 minutes prior to being moved into position for spinal anesthesia. VAS score is used to assess pain during positioning, and in the postoperative period for duration of analgesia and requirement of rescue analgesics. Statistical analysis used: Paired “t” test, and ANOVA for parametric data and Fischer’s test for categorical data. Results: Patients who received Dexamethasone as an adjuvant had significant prolongation of analgesia and required fewer rescue analgesics in the first postoperative day. No significant difference noticed in analgesia while positioning for spinal anesthesia. Conclusions: This study shows that FICB (total vol; 30 ml) provides preoperative analgesia, and Dexamethasone as adjuvant significantly prolongs the duration of block reducing the need for rescue analgesics over the first postoperative day.
Perspectives
Context: Femur fractures patients are in considerable pain on attempted hip flexion. Fascia Iliaca Compartment Block (FICB) is an effective means of providing analgesia during transit and positioning for spinal anesthesia which also persists postoperatively. Aims: To assess the preoperative and postoperative analgesic effect of Dexamethasone as adjuvant to Bupivacaine in FICB. Settings and Design: After obtaining ethical committee clearance, minimum sample size calculated from pilot studies was 64. Between Dec 2016– Feb 2017, 70 patients with proximal femur fractures posted for open reduction and internal fixation surgery were recruited for the study. Methods and Materials: Patients were randomly distributed into Control and Test Groups 35 patients received USG guided FICB with 28 ml 0.25% Bupivacaine + 2 ml Normal Saline and remaining received block with 28 ml 0.25% Bupivacaine + 2 ml (8 mg) Dexamethasone 20 minutes prior to being moved into position for spinal anesthesia. VAS score is used to assess pain during positioning, and in the postoperative period for duration of analgesia and requirement of rescue analgesics. Statistical analysis used: Paired “t” test, and ANOVA for parametric data and Fischer’s test for categorical data. Results: Patients who received Dexamethasone as an adjuvant had significant prolongation of analgesia and required fewer rescue analgesics in the first postoperative day. No significant difference noticed in analgesia while positioning for spinal anesthesia. Conclusions: This study shows that FICB (total vol; 30 ml) provides preoperative analgesia, and Dexamethasone as adjuvant significantly prolongs the duration of block reducing the need for rescue analgesics over the first postoperative day.
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This page is a summary of: A Prospective Comparative Study of Efficacy of Bupivacaine Alone or in Combination with Dexamethasone in Fascia Iliaca Compartment Block Prior to Subarachnoid Block for Fracture Femur Surgeries, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6619.53.
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