Key result
Combined femoral nerve block and spinal anesthesia provides similar analgesia to lumbar plexus block but takes longer.
Why the study?
The effect of combined femoral nerve block and spinal anesthesia on pain control after orthopedic surgeries has not been investigated and lumbar plexus block presents challenges.
Does combined femoral nerve block and spinal anesthesia improve perioperative pain management compared to lumbar plexus block in patients with femoral intertrochanteric fracture?
RCT (n=32)
randomly divided
Does combined femoral nerve block and spinal anesthesia improve perioperative pain management compared to lumbar plexus block in patients with femoral intertrochanteric fracture?
Absolute Event Rate: 17% vs 16.5%
p-value: p=0.873
Combined femoral nerve block with spinal anesthesia provides comparable analgesia duration to lumbar plexus block for intertrochanteric fracture surgery, despite requiring more time to perform.
Combined femoral-spinal block offers no analgesic advantage and takes longer; confirms equivalence to lumbar plexus block without procedural benefit.
BACKGROUND: Hip fracture-related pain both before and after surgery is generally reported as severe by most patients. Various regional pain control modalities have been described in order to reduce pain in these patients. OBJECTIVES: Because of the challenges of lumbar plexus block (LPB) and the fact that the effect of combined femoral nerve block/spinal anesthesia in controlling pain after orthopedic surgeries has not been investigated, in this study, we compared the feasibility and efficacy of the 2 techniques in the perioperative management of proximal hip fractures. PATIENTS AND METHODS: The study included 32 patients with femoral intertrochanteric fracture who were randomly divided into the following 2 groups of 16 patients each: combined femoral nerve block/spinal anesthesia group (group I) and LPB group (group II). Patients in group I received 0.17% bupivacaine with 0.7% lidocaine, 20-25 mL for femoral nerve block and bupivacaine 0.5% plus 0.5 mL pethidine (25 mg) for spinal block and patients in group II received 0.17% bupivacaine with 0.7% lidocaine, 30-35 mL. RESULTS: The time for performing the block (12.2 ± 3.3 vs. 4.93 ± 1.6 min, P = 0.001) and achieving the block (7.7 ± 0.9 vs. 2.4 ± 1.0 min, P = 0.001) were significantly longer in the combined femoral nerve block/spinal anesthesia group than in the LPB group. Duration of analgesia in the combined femoral nerve block/spinal anesthesia group was longer than that in the LPB group, but the difference was not significant (17 ± 7.3 vs. 16.5 ± 8.5 h, P = 0.873). There were no significant differences in hemodynamic parameters regarding the method of anesthesia in the 2 groups. CONCLUSIONS: This study confirms that the combination of femoral nerve block with spinal anesthesia is safe and comparable with LPB and can provide more effective anesthesia and longer lasting analgesia for intertrochanteric surgery.
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Amiri et al. (2012) conducted an RCT in femoral intertrochanteric fracture (n=32). Combined femoral nerve block and spinal anesthesia vs. Lumbar plexus block (LPB) was evaluated on Duration of analgesia (hours) (p=0.873). Combined femoral nerve block and spinal anesthesia provided similar duration of postoperative analgesia compared to lumbar plexus block (17 vs 16.5 hours, P=0.873) but took longer to perform.
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