Analgesia Before Performing a Spinal Block in the Sitting Position in Patients with Femoral Shaft Fracture: A Comparison Between Femoral Nerve Block and Intravenous Fentanyl

Abstract

We conducted this prospective, randomized study to compare the analgesic effect of femoral nerve block and IV fentanyl administration when given to facilitate the sitting position for spinal anesthesia in patients undergoing surgery for femoral shaft fracture. Five minutes before the placement of spinal block, group FEM patients (n = 10) received a femoral nerve block with lidocaine 1.5% 15 mL, and group IVA patients (n = 10) received IV fentanyl 3 microg/kg. Visual analog scale values during positioning (median and range) were lower in group FEM: 0.5 (0-1) versus 3 (2-6) (P < 0.001). Time to perform spinal anesthesia (mean +/- sd) was shorter in group FEM: 1.8 +/- 0.7 min versus 3.0 +/- 1.1 min (P < 0.05). Quality of patient positioning for spinal anesthesia (0 = not satisfactory, 1 = satisfactory, 2 = good, and 3 = optimal) (median and range) was higher in group FEM: 3 (2-3) versus 1.5 (1-3) (P < 0.005). Patient acceptance was less in group IVA (P < 0.05). In one group IVA patient, an oxygen saturation <90% was recorded during the procedure. We conclude that femoral nerve block is more advantageous than IV administration of fentanyl to facilitate the sitting position for spinal anesthesia in patients undergoing surgery for femoral shaft fractures.

Analgesia before Performing Subarachnoid Block in the Sitting Position in Patients with Proximal Femoral Fracture: A Comparison between Fascia Iliaca Block and Femoral Nerve Block

“…The time required for performing SAB with FICB was almost half a minute less than that of FNB in the present study. The performance time of FNB arm of our study is comparable to the time reported by Sia et al 10 However, longer SAB performance time of almost seven min has been reported by Yun et al following FICB.…”

Positioning for regional anesthesia in femur fracture surgeries: how effective is femoral nerve block? a randomised control study

“…Hence the procedure of patient positioning to perform a spinal block, in most cases, requires the administration of IV analgesics. 4 Various modalities like intravenous (IV) fentanyl (FENT), femoral nerve block (FNB) or fascia iliac block with local anaesthetic have been advocated to reduce the pain pre-operatively and improve the positioning of these patients. 4,5 Few studies have demonstrated that a fascia iliac compartment (FIC) block provides effective analgesia for a fractured femur in terms of facilitating an adequate position for spinal anaesthesia or when administered either during pre-hospital management or in emergency departments.…”

“…4 Various modalities like intravenous (IV) fentanyl (FENT), femoral nerve block (FNB) or fascia iliac block with local anaesthetic have been advocated to reduce the pain pre-operatively and improve the positioning of these patients. 4,5 Few studies have demonstrated that a fascia iliac compartment (FIC) block provides effective analgesia for a fractured femur in terms of facilitating an adequate position for spinal anaesthesia or when administered either during pre-hospital management or in emergency departments. [6][7][8] Systemic analgesics, such as narcotics, are commonly used, but their side effects profile including respiratory depression, cognitive impairment, vomiting, urinary retention, and others limits their clinical utility during injuries of the head, chest, or abdomen.…”

“…There is sufficient data to show the usefulness of FNB to relieve pain from fracture of the femur and now, is being used for positioning during central neuraxial blockade as well. 3,4,12,[19][20][21][22] Femoral nerve block can be performed using peripheral nerve stimulator, ultrasound guided technique or by loss of resistance technique. Geier KO concluded that there were no significant differences regarding efficiency between loss of resistance and peripheral nerve stimulator methods.…”

Comparative study of efficacy of femoral nerve block and IV fentanyl for positioning during femur fracture surgery

“…6,7 However due to the pain, analgesics or femoral nerve blockers are given to the patients, before positioning. 8,9 Femoral nerve blockers produce intense anaesthesia with very few side effects compared the opiods and NSAIDS. 10 In addition; the complications with the FNB are rare.…”