A prospective randomised controlled study, comparing efficacy of ultrasonography guided fascia iliaca compartment block and femoral nerve block in hip surgeries, for positioning the patient before spinal anaesthesia
Abstract
Background: Regional nerve blocks may alleviate pain and reduce the need for intravenous opiates in patients with hip and femoral neck fractures. Current prospective randomized study compares the onset times and pain management of Ultrasonography (USG) guided Femoral nerve block (FNB) and Fascia iliaca compartment block (FICB).
Materials and methods: Total 40 patients of ASA status I, II and III were randomized into two groups of 20 each: Group Fascia iliaca compartment block (FICB) received 20 ml of 0.75% Ropivacaine + 10 ml 2% LOX with adrenaline and Group Femoral nerve block (FNB) received 20 ml of 0.75% Ropivacaine + 10 ml 2% LOX with adrenaline. Patients were given the block under the guidance of ultrasound in the induction area by an anaesthesiologist and outcomes were analysed.
Results: The study finds no significant difference with regard to age, sex, weight distribution in both groups. At the time of block, the FNB group's mean VAS score was 6.25 ± 2.02, while the FICB groups was 6.80 ±1.15 which are comparable. In terms of analgesia efficacy, FICB group performed better than FNB group, as shown by the mean VAS score at SAB of 1.50 ±0.94, compared to 2.05 ±0.69 in FNB group. Analgesia sets in faster in the FICB group than in the FNB group, with the former taking an average of 122.45 ±13.76 seconds to complete the SAB post block, while the latter took an average of 113.85 ± 9.83 seconds. In comparison to the FNB group, FICB demonstrated higher degree of patient acceptance and better quality of position attainment to perform spinal anaesthesia.
Conclusion: FICB is superior to the FNB in terms of pain relief and the initiation of analgesic effects is earlier in the FICB.
Key words: Fascia iliaca compartment block, Femoral nerve block, Spinal anaesthesia, Visual Analogue Scale.
Downloads
References
2. Williams H, Paringe V, Shenoy S. Standard preoperative analgesia with or without fascia iliaca compartment block for femoral neck fractures. J Orthop Surg 2016; 24: 31–35.
3. Rashid A, Beswick E, Galitzine S. Regional analgesia in the emergency department for hip fractures: survey of current UK practice and its impact on services in a teaching hospital. Emerg Med J 2014; 31: 909–913.
4. Ritcey B, Pageau P, Woo MY. Regional nerve blocks for hip and femoral neck fractures in the emergency department: a systematic review. Canad. J.Emer.Med 2016; 18: 37–47.
5. Newman B, McCarthy L, Thomas PW. A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. Anaesthesia 2013; 68: 899-903.
6. Yang L, Li M, Chen C, Shen J. Fascia iliaca compartment block versus no block for pain control after lower limb surgery: A meta-analysis. J Pain Res 2017; 10: 2833-2841.
7. Somvanshi M, Tripathi A, Meena N. Femoral nerve block for acute pain relief in fracture shaft femur in an emergency ward. Saudi J Anaesth 2015; 9: 439-441.
8. Prashant K. Gupta, Kumkum Gupta. Potential role of ultrasound in anaesthesia and intensive care Anesth Essays Res 2011; 5(1): 11– 19.
9. Taylor PM. Ultrasound for anaesthetists. Curr Anaesth Crit Care 2003; 14: 237.
10. A.Hatfield, A.Bodenham ; Ultrasound: an emerging role in anaesthesia and intensive care. British J. anesthesia 1999; 83 (5): 789-800.
11. Omesh Singh, Yasir Al Khalili. Anatomy, Back, Lumbar plexus Treasure Island (FL): StatPearls Publishing; 2022.
12. Bigeleisen PE, Gofeld M, Orebaugh SL, Kluwer W, Ultrasound-Guided Regional Anaesthesia and Pain Medicine, 2nd edn. European Journal of Anaesthesiology: December 2015 - Volume 32 - Issue 12 - p 899.
13. Jain P N, Ranganathan P. Ultrasound in anaesthesia. Indian J Anaesthesia 2007; 51: 176-183.
14. Basinger H, Hogg JP. Anatomy, Abdomen and Pelvis: Femoral Triangle. StatPearls [Internet] : 2023
15. Capdevila X, Biboulet P,Bouregba M. Comparison of three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg 1998; 86 (5) : 1039-1044.
16. Jain N, Mathur PR, Patodi V. A comparative study of ultra-sound guided femoral nerve block versus fascia iliaca compartment block in patients with fracture femur for reducing pain associated with positioning for subarachnoid block. Indian J Pain Med 2018; 32 :150-154.
17. Dalens B, Vanneuville G, Tanguy A. Comparison of fascia iliaca compartment block with 3-in-1block in children. Anesth Analg 1989; 69 (6): 705-713.
18. Ghimire A, Bhattarai B, Koirala S. Analgesia before performing subarachnoid block in the sitting position in patients with proximal femoral fracture: a comparison between fascia iliaca block and femoral nerve block. Kathmandu Univ Med J (KUMJ) 2015; 13: 152–155.
19. Zheng T, Hu B, Zheng CY, Huang FY, Gao F, Zheng XC. Improvement of analgesic efficacy for total hip arthroplasty by a modified ultrasound-guided supra-inguinal fascia iliaca compartment block. BMC Anesthesiol 2021;21(1):75.
20. Kris Vermeylen Filiep Soetens Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study Regional Anaesthesia & Pain Med 2019; 44: 974-975
21. Sia S, Pelusio F, Barbagli R. Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: A comparison between femoral nerve block and intravenous fentanyl. Anesth Analg 2004; 99: 1221-1230.
22. Gupta M, Kamath SS. Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anaesthesia: an observational study. Korean J Pain 2020; 33(2): 138-143.
23. Noopur Dasmit Singh, Poonam Sachin Ghodki Ultrasound guided fascia iliaca compartment block versus femoral nerve block for positioning for spinal anaesthesia in patients with hip fracture Int J. Medical Anesthesiol 2020; 3: 236-240.
Copyright (c) 2024 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.