Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: an observational study

Abstract

Background: Severe pain associated with proximal femur fractures makes the positioning for regional anesthesia a challenge. Systemic administration of analgesics can have adverse effects. Individually, both the fascia iliaca block (FIB) and femoral nerve blocks (FNB) have been studied. However, there is little evidence comparing the two. The aim of this study was to compare the overall efficacy of the two blocks in patients with proximal femur fracture before positioning for spinal anesthesia. Methods: ASA (American Society of Anesthesiologists) class I, II, and III patients scheduled for elective and emergency surgery with the diagnosis of proximal femur fracture between October 2018 and June 2019 were included in the study. The patients were assigned to two groups by convenience nonprobability sampling of 35 each. Results: Our study showed a reduction in visual analogue scale scores at 3, 4, and 5 minutes after administration of the FIB being 5.1 ± 1.1, 4.1 ± 1.3, and 2.8 ± 0.8, and those after the FNB as 4.4 ± 1.1, 3.3 ± 1.1, and 2.1 ± 1.4 with P < 0.05, which was statistically significant. The mean first rescue analgesia time for the FIB was 7.1 ± 2.1 hours, while for the FNB it was 5.2 ± 0.7 hours. The P value was less than 0.001, which was significant. Conclusions: Both ultrasound guided FNB and FIB techniques provide sufficient analgesia for patient's positioning before spinal anesthesia. However, the duration of postoperative analgesia provided by FIB was greater than that of the FNB.

Nerve Stimulator vs Ultrasound-guided Femoral Nerve Block for Ease of Positioning before Spinal Anesthesia in Fracture Femur Patients: A Randomized Comparative Study

“…9 Gupta et al reported significant VAS reduction after 5 minutes in a group receiving US-guided FNB in fracture femur surgeries. 5 Similarly, in the present study we found earlier pain relief at 5 and 10 minutes in US-guided FNB as compared to NS-guided FNB. This was probably because of accurate drug deposition around the femoral nerve compared to blind placement in the case of group NS.…”

“…4 The duration of analgesia with US-guided FNB was 5.2 hours in the study by Gupta et al, whereas we had 7.7 hours, the difference may be due to the use of different local anaesthetics. 5 Singh et al found the duration of analgesia to be 6 hours with nerve stimulating technique of FNB using 0.2% ropivacaine, whereas it was 4.7 hours in our study. 12 This may be due to the additive effect of 0.75% ropivacaine used intra-spinally and top-ups of 0.2% ropivacaine used intraoperatively by them.…”

“…2,3 The femoral nerve block, a simple and easy to perform procedure, has been used both pre-emptively as well as post-operatively for fracture femur surgeries, anterior aspect of thigh or knee surgeries, or for physiotherapy after knee surgery. 2,3,5 Conventionally, landmark technique with a nerve stimulator (NS) has been used in the past to achieve precise localization of nerves with high efficiency. 6,7 Liu et al attributed this success rate to the experience and expertise of anaesthesiologists.…”

Anatomical and Radiological Assessments of Injectate Spread Stratified by the Volume of the Pericapsular Nerve Group Block

“…[5][6][7][8] However, the literature has suggested that these blocks do not cover the ON sufficiently 12,13 and carry a high risk of quadriceps weakness. [14][15][16][17] An ultrasound-guided suprainguinal ligament approach to the fascia iliaca compartment has proven better spread of local anaesthetics to the ON located medial to the psoas muscle. However, it also weakens the muscle strength of the operated leg, delaying optimal rehabilitation.…”