Ultrasound-guided supra-inguinal fascia Iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial

Background Hip fracture is common in older adults, and can cause severe post-fracture pain. Fascia iliaca nerve block has consequently been used for preoperative analgesia. Methods We performed a randomized, controlled, double-blind clinical trial and recruited older patients with hip fractures. These patients were randomized into two groups and received ultrasound-guided fascia iliaca compartment block using either the supra-inguinal approach (group F) or the classical approach (group C). Heart rate, blood pressure, and resting and exercising visual analog scales were recorded before the procedure and at 30 min, and 6, 12, and 24 h after completion of the procedure. We recorded the duration of the procedure—as well as complications such as bleeding, hypotension, and intractable vomiting; the sleep duration in a 24 h period was also documented. Results A total of 38 patients completed the trial, and we observed no differences in the baseline characteristics or pre-procedural measurements between the two groups. Compared with the patients in group C, patients in group F exhibited significantly lower exercising VAS scores at 6 and 12 h after the procedure, faster heart rates at 6 and 24 h after the procedure, a longer procedural duration, and a longer sleep duration. There were no differences in the frequencies of complications between the two groups. The percentages of patients who took oral analgesics and the numbers of medications consumed were also not different between the two groups. Conclusions The supra-inguinal FICB provided effective analgesia and improved exercise tolerance compared with the classical approach. Trial registration The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100045644, registration date: 2021 April 20).

AN OBSERVATIONAL STUDY TO COMPARE THE EFFICACY OF ROPIVACAINE ALONE AND ROPIVACAINE WITH DEXMEDETOMIDINE IN ULTRASOUND GUIDED FASCIA ILIACA COMPARTMENT BLOCK FOR ANALGESIA IN POSITIONING OF THE PATIENT IN SUBARACHNOID BLOCK PERFORMED IN UNILATERAL FEMUR FRACTURE SURGERY

Introduction: Patients encountered with fracture shaft and neck femur require some anaesthesia or pain relief to allow radiological, orthopedic and other procedures to be performed. Regional anaesthesia is the most widely used an aesthetic technique for orthopedic procedures in lower limbs.Fascia iliaca blocks provide a safe, cheap and effective form of pain relief for patients with neck of femur fractures. Animal studies have proven the combination of dexmedetomidine with ropivacaine to be safe and neuro-protective. Fascia iliaca compartment block which involve femoral nerve, lateral cutaneous nerve of thigh and obturator nerve. This study is designed to compare Fascia Iliaca Compartment Block under ultrasound guidance with ropivacaine and ropivacaine plus dexmedetomidine positioning during spinal anesthesia in femur fractures. Material and methods: This study was conducted at Mahatma Gandhi hospital and Mathuradas Mathur hospital, Jodhpur during January 2019–January 2020. 60 Patients admitted in Orthopaedic ward age group 21-60 yrs. of both sex were the source of data. Patients undergoing elective surgery for fracture femur (neck of femur and intertrochanteric) under SAB were included in the study. We divided the cases into 2 groups of 30 each, as GROUP R: Patients were received 30 ml 0.50% Inj. ropivacaine + 2 ml Normal saline with a total volume of 32 ml in unilateral FICB. GROUP RD: Patients were received 30 ml 0.50% Inj. Ropivacaine + 2 ml Inj. Dexmeditomidine (0.5mcg/Kg) with a total volume of 32 ml in unilateral FICB. Standard protocol followed to administering regional anaesthesia. All data were collected and analysed with the help of suitable statistical parameters. Results: Our study results in that Fascia Iliaca Compartment Block with combination of ropivacaine and dexmedetomidine is more efficacious than ropivacaine alone for positioning during spinal anaesthesia in surgery for fracture femur. Key words: Spinal Anaesthesia, Fascia Iliaca Compartment Block, Ropivacaine, Dexmedetomidine.