Anesthesiology Comparative study of Ultrasound guided fascia iliaca block and femoral nerve block to assist positioning in spinal anaesthesia

USG guided fascia iliaca compartment block and femoral nerve block to assist the technique of spinal anaesthesia

Abstract

Objectives:-Proximal femur fractures are very painful, making positioning for regional anaesthesia a challenge. Peripheral nerve blocks are safe and effective for analgesia with advantages of  opioid-sparing affects . This study compares the analgesic efficacy of  ultrasound- guided fascia iliac compartment block (FICB) and femoral nerve block (FNB) for optimal positioning during spinal anesthesia  for proximal femur fracture surgeries.

 Methods:- Ninety patients belonging to ASA 1, II and III, who were posted for surgery on proximal femur fractures and randomly allocated   into two groups  45 in each group. Group A patients received USG guided fascia iliaca block and Group B patients received USG guided femoral nerve block. Pain during positioning for spinal anaesthesia was the primary outcome and was assessed using the Numerical rating scale (NRS) scores.

Results:  Time to onset of block was 4.3±0.9 mins in FICB group and 2.8±0.6 mins in FNB group (p<0.001). Time to perform block was 8.52 ± 2.32  mins in FICB group and 5.12 ± 1.22 mins in FNB group (p<0.001). Statistically significant difference was seen between the study groups at  10 mins, 15 mins and 30 mins after study intervention in terms of NRS pain scores.

Conclusion: We conclude that both the femoral nerve block (FNB) and the fascia iliaca compartment block (FICB) using ultrasound guidance are simple and effective . In our study, patients in the group B (FNB) had lower NRS scores compared to the group A (FICB) .The Ultrasound-guided FNB may offer faster onset of block and better pain relief than FICB for assisting in  positioning for spinal anaesthesia in patients with proximal femur fractures.

Keywords:- Bupivacaine, femoral nerve block, fascia iliaca compartment block,  femur fractures,  spinal anaesthesia.