Evaluation of Ultrasound-guided Pre-emptive Fascia Iliaca Compartment Block for Postoperative Analgesia in Femur and Hip Fracture Surgeries: A Randomised Controlled Trial

Abstract

Introduction: Spinal anaesthesia is the preferred anaesthetic technique for fractures of the hip and femur. Ultrasound-guided Fascia Iliaca Compartment Block (FICB) provides more intense analgesia which can prolong the duration of postoperative analgesia and also mitigate the pain encountered while positioning for spinal anaesthesia. Aim: To evaluate the efficacy of ultrasound-guided pre-emptive FICB in hip and femur fracture surgeries. Materials and Methods: This randomised, double-blinded, control study was conducted between May 2019 to December 2019, at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Total 66 patients scheduled for hip and femur fracture surgeries under spinal anaesthesia were randomly divided into two groups i.e, group A received Ultrasound-Guided (UG) FICB preoperatively and group B received no block. All the patients received fentanyl 1 mcg/kg intravenous (i.v.) 15 min before spinal anaesthesia. The Anaesthesiologist performing spinal anaesthesia graded the score of positioning as 0 as not satisfactory, 1 as satisfactory, 2 as good, 3 as optimal. The time for the first request for analgesia, consumption of analgesics and Visual Analog Scale (VAS) scores for 24 hours postoperatively and any adverse effects were compared between the two groups. Student’s t-test was used to compare continuous data and unpaired t-test for categorical data. Results: The time for the first request for analgesia was 671.52±66.73 min in group A and 480.3±57.65 min in group B and was statistically significant (p-value <0.0001). In group A, the quality of positioning for spinal anaesthesia was optimal in 13 patients and good in 14 patients. In group B, it was unsatisfactory in 12 patients and just satisfactory in four patients (p-value=0.0009). Majority of the patients (24) in group A required three doses of paracetamol, while 26 patients required two doses for group B. The total number of doses for tramadol was 4 in group A, and 13 in group B. The VAS scores were reduced at the 8th and 10th hours following surgery in group A. No adverse effects were encountered in the study. Conclusion: The FICB prolongs the time to first request for analgesia postoperatively, improves patient positioning for spinal anaesthesia, reduces the consumption of analgesics, and improves VAS scores postoperatively without any adverse effects.

Keywords

• analgesia
• patient positioning
• spinal anaesthesia
• ultrasonography
• visual analog scale