Introduction: Systemic postoperative analgesia is inefficient in most patients with hip fracture, which is the reason for pain, especially during leg movement. Peripheral and plexus nerve blocks are an efficient option for postoperative pain relief. The aim of this study was to compare the effect and duration of continuous FNB versus a single FIC block as a postoperative analgesia in patients with hip fracture. Methods: Sixty patients with hip fracture were included and were randomly assigned to two groups of 30 patients: FNB group -patients with continuous femoral nerve block; and FIC group -patients with a single fascia iliaca compartment block. In all patients, pain intensity was measured at rest and in passive leg movement by using VDS (0-4) at several intervals: 1, 2, 12, 24, 36 and 48 hours after intervention. The amount of supplemental analgesia was measured, together with the time when the patient needed it for the first time, as well as the side effects. Results: The values of VDS were significantly lower in patients with FNB block versus patients with FIC block in rest and movement at the 24-hour intervals (46.67% vs 0% felt moderate pain), after 36 hours (43.33% vs 0% felt moderate pain) and 48 hours after intervention (46.67% vs 3.33% felt moderate to severe pain) for p < 0.05. Patients with FNB block received a significantly lower amount of supplemental analgesia, 23.3% of the FNB group vs 50% of the FIC group (p < 0.05). Registered side effects were were nausea, dizziness and sedation, and they were statistically significantly more frequent in the FIC group (p < 0.05). Conclusion: Pain relief in the postoperative period was superior in the FNB group versus the FIC group at rest and in movement in patients with hip fracture.

Introduction. Patients with hip fracture are usually older patients. Uncontrolled acute pain and surgical stress in elderly patients may cause increased cardiac morbidity and mortality. Epidural analgesia blocks sympathetic nervous system and reduces the incidence of myocardial ischemia and dysrhythmias as well as the response to stress. Methods. Sixty patients with hip fracture older than 65 years with previously defined high peroperative cardiac risk according to ACC/AHA guidelines were included and were randomly assigned to two groups of 30 patients: SA group-patients with systemic analgesia. niflam 2 × 100 mg/iv and tramadol 1 mg/kg/iv every 8 hours; and EDC group-patients with a continuous epidural analgesia with bupivacaine 0.125%-5 ml/h and fentanyl 3 µg/ml. As end points of the study the incidence of cardiac events in both groups were registered: cardiac death, myocardial infarction, congestive heart failure, unstable angina and new-onset atrial fibrillation. Laboratory parameters and pain intensity were determined in all patients by using Verbal Descriptive Scale. Side effects were also monitored. Results. The epidural analgesia decreased the incidence of peroperative cardiac events in patients with high per-operative cardiac risk for hip fracture surgery (46.6% in SA group vs. 15% in EDC group) and at the same time decreased cardiac mortality (10% in SA group vs. 0% in EDC group). The values of VDS were significantly lower in patients with EDC block versus patients with systemic analgesia in all experimental times and there was a smaller number of side effects. Conclusion. Early administration of continuous epidural analgesia in patients with high peroperative risk with hip fracture decreases the incidence of cardiac morbidity and mortality and provides superior pre- and post-operative analgesia compared to systemic analgesia with minimal side effects.