KUMJ | VOL. 14 | NO. 2 | ISSUE 54 | APR-JUN. 2016
Ultrasound Guided Femoral Nerve Block to Provide Analgesia for Positioning Patients with Femur Fracture Before Subarachnoid Block: Comparison with Intravenous FentanylAbstract:
Ranjit S, Pradhan BB
Positioning patients with fractured femur for subarachnoid block is painful.
Intravenous analgesics or peripheral nerve block like femoral nerve block or fascia
iliaca compartment block are some of the available techniques to reduce pain. We
compared the efficacy of femoral nerve block and intravenous fentanyl in providing
effective analgesia before positioning for subarachnoid block.
This study was designed to compare between ultrasound guided femoral nerve block
with lignocaine and intravenous fentanyl in providing effective analgesia before
positioning patient with femur fracture in sitting position for subarachnoid block.
Forty patients undergoing surgery for femur fracture were randomized to either
femoral nerve block (FNB) or intravenous fentanyl (IVF) group. Group FNB (n=20)
received 20 ml of 2% lignocaine around femoral nerve under ultrasound guidance.
IVF group (n=20) received 2 mc/kg of fentanyl intravenously. Pain score on effected
limb was assessed after five minutes. If VAS was ≤ 4, the patient was positioned in
sitting for subarachnoid block. On failure to achieve this with the above treatment,
intravenous fentanyl 0.5 mc/kg was administered and repeated as necessary before
VAS during positioning was documented and compared between the two groups.
Similarly, secondary outcomes of the intervention: quality of patient position, rescue
analgesia and duration of the procedure were also compared. Data were subjected
to Mann Whitney U-test and chi-square test. Level of significance was set at 0.05.
FNB group had significantly less VAS scores (median) than IVF group :2 vs 3;
p=0.037) during positioning for spinal anaesthesia. Procedure time (median) for
spinal anaesthesia was also significantly less in FNB than in IVA group (10 vs 12 min;
Ultrasound guided femoral nerve block was more effective than intravenous fentanyl
for reducing pain in patients with proximal femur fracture before spinal anaesthesia.Keyword :
Femoral nerve block, fractured femur, positioning before subarachnoid block, ultrasound guided