COMPARATIVE EVALUATION OF USG GUIDED FEMORAL NERVE BLOCK AND INTRAVENOUS FENTANYL FOR POSITIONING DURING SPINAL ANAESTHESIA IN SURGERY OF FEMUR FRACTURE
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Keywords
Ultrasound, Femoral Nerve Block, Anaesthesia, femur fracture, fentanyl, position for spinal, spinal anesthesia
Abstract
Background: Femoral fractures are one of the most common fractures represented with an annual prevalence of around 2.9 million cases worldwide. Spinal anaesthesia is the preferred technique to fix fracture of the femur. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during positioning for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl.
Aim: Our aim was to assess the effectiveness of ultrasound (USG) guided femoral nerve block (FNB) and intravenous (IV) fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture:
Methods: It was a prospective observational study conducted at Government Medical College Kathua in the department of anesthesia on 80 patients of ASA I and II class of age group (20 - 70 years) old, posted for fracture femur surgeries under spinal anaesthesia. Patients were randomized into two groups Group A (N = 40) received USG guided femoral nerve block and Patients in the fentanyl group, Group B (N=40) received injection fentanyl 1 µg/ kg IV 10mins prior to positioning. Parameters recorded included VAS at baseline, 10 mins and during positioning, anaesthesiologist’s satisfaction (yes or no), total Tramadol consumption and patient’s satisfaction (Likert scale).
Results: Demographic variables were comparable in both groups. Mean pain intensity in the VAS score at the time of admission to the operating room was 6.9±0.9, which was reduced to 2.7±0.9 after blockade. In this study, (74%) patients were very satisfied (Likert scale 5), (18%) were satisfied (Likert scale 4), (4%) had no opinion (Likert scale 3), (4%) were not satisfied (Likert scale 2), and no one was dissatisfied (Likert scale 1). VAS in Group A 10 mins and during positioning was 2.5 ± 1.09 and 3.2 ± 0.31 in comparison to 6.56 ± 0.67 and 7.4 ± 0.82 in Group B respectively. Anaesthesiologists and patient’s satisfaction were much higher in Group A.
Conclusion: USG - guided femoral nerve block (FNB) as compared to intravenous fentanyl, before positioning for spinal anaesthesia for fracture femur is very effective in controlling pain during positioning for spinal anaesthesia. This analgesia block is a safe and effective to be used for positioning prior to spinal anesthesia and it prolongs post operative analgesia.
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Dr. Shivani Sharma
Senior Resident, Department of Anesthesia Government Medical College Jammu, India
Dr. Preeti Jamwal
Senior Resident, Department of Anesthesia, Government Medical College Kathua, India
Dr. Mohinder Singh Chib
Consultant Orthopedics in Gupta Hospital and research centre (GHRC) Kathua, India.
Dr. Deepika Jamwal
Consultant, Department of gynaecology and obstetrics, Government Medical College Kathua, India.