Femoral Nerve Block Versus Intravenous Analgesireemptive Analgesic For Positioning Of Spinal Anaesthesia In Fracture Femur: A Randomised Comparative Study

Abstract

Background: Fracture femur is one of the most common orthopaedic problem following trauma in patients of all ages. The preferred method of anaesthesia in these patients is central neuraxial blockade such as spinal anaesthesia which requires correct positioning. This randomised comparative study was conducted to compare the analgesic effects of Femoral Nerve Block using Ropivacaine with intravenous (I.V) Fentanyl prior to positioning for central neuraxial blockade using spinal anaesthesia in patients undergoing fracture femur surgeries. Aim: This study was conducted to evaluate better analgesic mode in terms of pain relief on visual analog scale during positioning, time to perform spinal anaesthesia, the quality of positioning and acceptance of patients with fracture femur. Objectives: Comparison of the analgesic effects of Femoral Nerve Block (FNB) with Intravenous Fentanyl 15 minutes prior to positioning for a spinal block in patients with fracture femur with the aid of primary outcomes like efficacy of analgesia, ease of positioning for spinal anaesthesia, patient satisfaction, time to perform spinal anaesthesia. Secondary outcomes like duration of spinal anaesthesia, first rescue analgesic dose after spinal anaesthesia and complications.Methodology: This randomised comparative study was conducted on 80 ASA I and II patients of either gender aged between 30 – 70 years posted for fracture femur surgeries. The patients were randomly selected and divided by computer generated random number tables in to two groups with 40 patients in each group. Group I patients were given Femoral Nerve Block with 15 ml of 0.2 % Ropivacaine using USG. Group II patients were given I.V. Fentanyl 0.5 mcg/kg. Data was analysed using chi-square test and ‘t’ test. Results: Significant difference was observed between the two groups in efficacy of analgesia (group I- 3.750±1.1929 and group II- 5.900±1.1503; p<0.001), time to perform spinalanaesthesia (group I- 4.050±1.280 and group II- 6.725±1.0857; p<0.001), duration of spinal anaesthesia (group I- 3.925±0.4319 and group II- 3.300±0.2953; p<0.001), first rescue analgesic dose (group I- 6.325±1.3134 and group II- 4.013±0.473; p<0.001). The percentage of patients with successful positioning for spinal anaesthesia and patient satisfaction were statistically significant and higher and had considerably lower percentage of complications in group I than in group II. Conclusion: Femoral Nerve Block is a better preemptive analgesia than intravenous Fentanyl to facilitate positioning for central neuraxial blockade in patients undergoing fracture femur surgeries.