Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia for surgery of femur fracture

Sir, I read with great interest the article ‘Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia’. The authors concluded that femoral nerve block provides better analgesia, patient satisfaction, and satisfactory positioning than intravenous fentanyl for position during spinal anaesthesia in patients of fracture femur. However, I feel that the following points should be considered while doing a femoral nerve block.[1] The authors in the study used the classic technique of femoral nerve block. Most of the patients included in the study 45/60 (75%) had proximal rather than fracture of distal or shaft of the femur. Three in one femoral block or fascia iliaca block are more effective than a classic femoral block in the proximal femoral fracture as it gives anaesthesia to femoral, obturator and lateral cutaneous nerves which innervates the hip joint.[2] In three-in-one technique of femoral nerve block, application of pressure 2–4 cm below the injection site after administration of the local anesthetic (LA) solution will help in spreading of the LA solution proximally and block the obturator and lateral femoral cutaneous nerve in addition to the femoral nerve and will provide more effective analgesia.