Effectiveness of Femoral Nerve Block versus Intravenous Nalbuphine in Positioning of Patients with Intertrochanteric Fractures for Spinal Anaesthesia: A Randomised Clinical Study

Abstract

Introduction: Femoral fracture is a common entity in all age groups. It is more common in elderly, and is a painful condition. Various modalities like peripheral nerve blocks, intravenous opioids can mitigate the pain associated with it, which is deterrent to ideal patient positioning for spinal anaesthesia. Aim: To compare the effectiveness of Femoral Nerve Block (FNB) versus Intravenous Nalbuphine (IVN) in positioning of patients with intertrochanteric fracture for spinal anaesthesia. Materials and Methods: A randomised clinical study was conducted in 70 patients of American Society of Anaesthesiologists (ASA) physical status I and II, with intertrochanteric fractures posted for surgery under subarachnoid block. Group IVN received intravenous Nalbuphine at dose of 0.1 mg/kg, and Group FNB received femoral nerve block with 20 mL of 0.2% ropivacaine 15 minutes, prior to positioning of patients for subarachnoid block. The ease of patient positioning was assessed by the pain relief observed during positioning for spinal anaesthesia, and by means of anaesthesiologist satisfaction score. Time taken to position the patients during spinal anaesthesia, and patient satisfaction scores were also measured. Independent ‘t’ test and Mann-Whitney U test were used for the analysis. Results: The Visual Analogue Scale (VAS) score achieved during positioning of patients for subarachnoid block was significantly better in FNB (3.87±0.99), as compared to IVN (5.09±1.23). No significant differences were observed between both the groups regarding anaesthesiologist satisfaction score, (p=0.11). Time taken for positioning of patients for spinal anaesthesia in seconds (p=0.69), and patient satisfaction score (p=0.08) were also comparable between both groups of patients. Conclusion: FNB is more effective for positioning of patients of intertrochanteric fractures for spinal anaesthesia. Although either of the techniques can be adopted for improving patient care, FNB may have an edge over IVN.

Keywords

• femoral fracture
• pain relief
• patient positioning
• subarachnoid block