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

Abstract

Background: Fracture of the femur is a common orthopaedic problem following trauma in patients of all ages. This study was undertaken to evaluate the effectiveness of femoral nerve block (FNB) in positioning the patients for regional anesthesia.Methods: 100 patients between the ages 18 to 80 years, of ASA grade I, II and III, scheduled for elective surgeries of femur fracture were evaluated in 2 groups. Group FNB (n=50) received femoral nerve block with 15ml of 1.5% lignocaine and Group. Non FNB (n=50) was not given any block. Assessment of pain was carried out using visual analog scale (VAS). This was rated before, during and after the procedure of positioning for spinal/combined spinal epidural anesthesia (CSE). Vital parameters were tabulated.Results: VAS scores were noted at 0, 2, 5,10,15 minutes and at the time of positioning. VAS scores at 15 minutes after FNB was 1.473 ±0.1639 and 8.250±0.3615 in patients without FNB. Time taken for CSE was significantly less in FNB group (13.026±0.4628) minutes as compared to non FNB group (19.660 ±0.3742) minutes. Patient satisfaction scores were significantly higher in FNB group (45/50) 1.4952±0.033 as compared to non FNB group (10/50) 0.3460±0.1786. Quality of patient positioning was better in FNB group (2.782 ±0.1273) as compared to non FNB (1.382±0.2473).Conclusions:This study concludes that FNB is highly effective in giving good pain relief for positioning for regional anaesthetic procedures improving performance time and offers higher acceptance among patients with femoral fractures.

<p>Comparing Analgesic Effect of Intravenous Fentanyl, Femoral Nerve Block and Fascia Iliaca Block During Spinal Anesthesia Positioning in Elective Adult Patients Undergoing Femoral Fracture Surgery: a Randomized Controlled Trial</p>

“…The present study shows that FNB and FICB were effective in reducing pain during positioning than IVFE [median (IQR)]; 2(1–2.5), 2(2–3)) vs. 3(3–4) respectively, which is comparable with recent studies done by Purohit et al, 17 comparing placebo-controlled FNB that showed VAS score of (mean± SD (8.25±0.36,1.47±0.16)) respectively and Hsu et al, 16 comparing FNB and intravenous opioids. Madabushi et al, 13 which compares FICB to IVFE also showed similar results to the present study.…”

“…In the present study quality of positioning was higher in patients with FNB or FICB 2(2-3) for both groups than IVFE 2(1-2) which is also comparable to previous studies by Purohit et al, 17 (2.8±1.3, 1.4±0.2), Madabushi et al, 13 (2.06±078, 1.25±0.85) and Hsu et al 16 This study shows that patient acceptance was greater in patients with FNB and FICB than IVFE (87.5%, 79%, and 41.7%) respectively. This is in line with previous studies done by Purohit et al, 17 (90%, 20%) for FNB vs. non FNB groups and Hsu et al, 16 also showed regional nerve blocks provide greater patient acceptance than intravenous opioids.…”

“…In this study, there is no documented complication like hypotension, vomiting, bradycardia, and respiratory depression which is similar to studies done by Kacha et al, 12 and Purohit et al, 17 on their placebo-controlled FICB and FNB randomized clinical trials respectively.…”

“…The present study is comparable to many studies that showed peripheral nerve blocks; FNB or FICB were more effective in reducing pain during positioning, shorten time to perform central neuraxial block, and increase the quality of positioning than placebo or intravenous opioids including fentanyl, alfentanil and nalbuphine. 12,13,17,18 FNB and FICB can be used for a longer time by placing a catheter to the site for additional bolus, continuous infusion of local anesthetics or using long acting local anesthetics. 19 Pre-spinal FICB or FNB relax quadriceps muscle thus provide superior analgesia for positioning, a better quality of positioning, and require shorter time to perform spinal anesthesia.…”

Оцінка Ефективності Спинномозкової Анестезії При операціях На Нижніх Кінцівках Хворих Працездатного Віку

“…Саме тому у вітчизняній практиці при знеболюванні перед операцією на нижніх кінцівках віддають перевагу методам регіонарної анестезії. Одним із найпоширеніших із них є спинномозкова анестезія, яка має такі очевидні переваги, як простота та швидкість виконання, надійне знеболювання [10,11].…”