Key result
Fascia iliaca compartment block with 0.25% levo-bupivacaine provided significantly greater pain reduction during patient positioning for spinal anesthesia compared to intravenous fentanyl (mean VAS reduction 5.05 vs 3.0, p=0.0001).
Why the study?
Patients with femoral neck fractures experience significant pain during positioning for spinal anaesthesia, and regional techniques like fascia iliaca compartment block may offer a safe alternative to intravenous analgesics.
Does Fascia Iliaca compartment block with levo-bupivacaine improve analgesia and patient positioning compared to intravenous fentanyl in patients with fracture femur undergoing spinal anaesthesia?
RCT (n=60)
Double-blind
Computer-generated number sequence
No
Does Fascia Iliaca compartment block with levo-bupivacaine improve analgesia and patient positioning compared to intravenous fentanyl in patients with fracture femur undergoing spinal anaesthesia?
Absolute Event Rate: 5.05% vs 3%
p-value: p=0.0001
Fascia iliaca compartment block with levo-bupivacaine provides superior analgesia and facilitates better patient positioning for spinal anaesthesia compared to intravenous fentanyl in patients with femur fractures.
May reduce positioning pain for spinal anesthesia in hip fracture patients; leaves open superiority to IV analgesics or other blocks in RCTs.
Introduction: Femoral neck fractures are often encountered in the elderly who may have many concurrent medical conditions. These patients are treated by surgery, more commonly under spinal anaesthesia. But the patients experience a significant amount of pain during positioning for administration of spinal anaesthesia. To alleviate this pain during positioning, multiple intravenous analgesics have been used. Recently regional blocks have gained popularity for the same purpose. Fascia iliaca compartment block (FICB) is one such safe alternative. Method: 60 patients were divided into 2 groups of 30 each by computer- generated number sequence. Group 1: Received the Fascia Iliaca compartment block with 20 ml of 0.25% levo-bupivacaine 15 minutes before the subarachnoid block. Group 2: Received Intravenous fentanyl at 1 mcg/ kg single dose 15 minutes before the subarachnoid block. Result: The mean VAS of group 1 was lower than that of group 2. The difference in VAS after the block and after the drug was statistically significant. Conclusion: Fascia iliaca compartment block is better than fentanyl for providing analgesia during patient positioning in patients of fracture femur.
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Srinivas et al. (2021) conducted an RCT in Fracture of femur (n=60). Fascia Iliaca compartment block with levo-bupivacaine vs. Intravenous fentanyl (1 mcg/kg) was evaluated on Difference in Visual Analogue Scale (VAS) score before and after analgesia (p=0.0001). Fascia iliaca compartment block with 0.25% levo-bupivacaine provided significantly greater pain reduction during patient positioning for spinal anesthesia compared to intravenous fentanyl (mean VAS reduction 5.05 vs 3.0, p=0.0001).
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