A Comparative Study on the Effects of Pre-Operative Fascia Iliaca Plane Block on Hip Surgeries Done Under Spinal Anaesthesia in Elderly Patients, vs. No Block on Post Operative Pain Scores

Abstract

BACKGROUND Hip surgery is one of the common surgeries performed in orthopaedics. It is mainly done in elderly population as they are more prone to fractures, due to osteoporotic bone and tendency to fall. Pain reduction is a major concern in this group due to advanced age and associated comorbid conditions. In addition to patient suffering, pain leads to increased hospital stay and morbidity due to delirium. Effort has been made to reduce pain by giving opioids, NSAIDS, long acting intrathecal opioids, epidurals and recently using nerve blocks especially using ultrasound. Several blocks have been tried like femoral nerve block, three in one block, fascia iliaca block and sciatic block. The advantage of intraoperative block is the continuation of effect in post-operative period, less requirement of opioids and early mobilization, less delirium and overall less initial mortality. Here we tried to study the effect of intraoperative 35% ropivacaine and dexmedetomidine 50 micrograms given as FICB. MATERIALS AND METHODS 50 elderly patients with only hip fracture admitted between 2017 to 2018, above 60 years of age, were subjected to the study. Patients included those who consented to procedure under spinal anaesthesia. They were explained about the procedure, the willingness for block, the risk factors involved and taught about VAS scale for pain assessment. Inclusion Criteria-Elderly patients above 60 years of age, male/female, hip surgery alone, cases done under spinal with 5% bupivacaine. Exclusion Criteria-Patients with contraindications for block like coagulopathy-including drug induced, infection at site, inguinal hernia, poor mentation, stroke, patient refusal, allergy to any of the drug component, patient with bradycardia with heart rate less than 60. RESULTS The patients who were given preoperative blocks were having analgesia for over 8 hours to 18.3 hours. They had a satisfactory VAS score of less than 3 up to 24 hr with paracetamol and rescue doses of tramadol. CONCLUSION FICB is effective fascial plane block for post-operative hip pain. It reduces the post-operative stay. Mixing dexmedetomidine increases the total duration by 18-24.3 hrs. with minimum hemodynamic instability and sedation.