Compartment Block Prior to Subarachnoid Block in Patients Undergoing Fracture Femur Surgeries

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Compartment Block Prior to Subarachnoid Block in Patients Undergoing Fracture Femur Surgeries

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Background: Pain arising from fracture of femur is of severe nature, and any degree of movement can worsen the pain. Surgery for fixation of femoral fractures may be done under spinal anesthesia. Fascia Iliaca Compartment Block (FICB) produces a simultaneous block of the femoral and of the lateral femoral cutaneous nerves, provides good pain relief for patients with fracture femur and even intravenous fentanyl can also be used to relieve the pain. Aims: We conducted this study to compare the analgesic efficacy of Intravenous Fentanyl (IVF) and Ultrasonography (USG) Fascia Iliaca Compartment Block (FICB) for preoperative pain relief and while positioning for subarachnoid blockand also to assess the duration and quality of postoperative analgesia in the first 12 hrs. Materials and Methods: Sixty patients aged 18 to 65 years, with American Society of Anesthesiologists status I to II, undergoing surgery for femur fracture were chosen for the study and randomized into 2 groups. Group A (n = 30) received 1 mcg/kg fentanyl Intravenously and Group B (n = 30) underwent ultrasonography (USG) guided FICB with 0.5% Bupivacaine of 20 ml volume, 20 minutes prior to positioning for subarachnoid block. Preprocedural and postprocedural parameters such as hemodynamic parameters, visual analog scale (VAS) scores for 12 hours and quality of positioning and request of first rescue analgesia were recorded. Results: Preprocedural VAS scores were similar in both groups. Postprocedure VAS score in Group B was significantly less compared to Group A. Patients in Group B had better quality of positioning for subarachnoid block. Requirement of first rescue analgesia was prolonged in Group B compared to Group A. Conclusion: FICB group patients had better quality of positioning subarachnoid block and prolonged postoperative analgesia. This suggests USG guided FICB is an effective way to reduce patient discomfort during positioning for subarachnoid block in femoral fractures and prolong postoperative analgesia.

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