A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture

Background & objective: Spinal anesthesia (SA) is preferred for fractured femur surgery but it requires proper positioning which is often very difficult to achieve due to pain. Different methods have been used to control the pain during patient positioning, but the results are inconsistent about the superiority of one over the other. We compared femoral nerve block (FNB) and intravenous ketamine for pain control during positioning for SA in elderly patients with femur fracture. Methodology: A total of 66 patients above 60 y of age were randomly divided into two equal groups; FNB group to receive ultrasound guided FNB with 15-20 ml of bupivacaine 0.25% and ketamine group to receive IV ketamine 0.25 mg/kg. Assessment of VAS scores during positioning before SA was done. Rescue analgesia for pain during positioning was achieved by inj fentanyl IV, and after the surgery by inj morphine IV. Postoperative VAS scores, calculation of total morphine consumption during the first 24 h and any complications were recorded. Results: The VAS score during positioning was lower in FNB group compared to ketamine group (P < 0.001). This was evident by lower recorded doses of pre-spinal rescue fentanyl. FNB group showed better postoperative analgesia, less morphine consumption and less complications. Conclusion: FNB provided better analgesia during positioning for spinal blockade in fractured femur patients. Furthermore, FNB was associated with less adverse effects, better postoperative analgesia and less opioid consumption. Trial Registry: PACTR202112605652525. Abbreviations: SA - Spinal anesthesia; FNB - Femoral nerve block; NSAIDS - Nonsteroidal anti-inflammatory drugs; VAS - Visual Analog Scale Key words: Pain; Spinal anesthesia; Femoral nerve block; Ketamine; Femur surgery Citation: Moussa MEM, Awad HGS, Hamid HSA, Abdellatif AE, Sharaf AGS. A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture. Anaesth. pain intensive care 2022;26(3):297-303. DOI: 10.35975/apic.v26i3.1895 Received: January 25, 2022, Reviewed: March 16, 2022, Accepted: March 23, 2022