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Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: an observational study

  • Gupta, Meeta (Department of Anesthesiology, Kasturba Medical College of Mangalore, Manipal Academy of Higher Education) ;
  • Kamath, Shaila Surendra (Department of Anesthesiology, Kasturba Medical College of Mangalore, Manipal Academy of Higher Education)
  • 투고 : 2019.12.05
  • 심사 : 2020.01.28
  • 발행 : 2020.04.01

초록

Background: Severe pain associated with proximal femur fractures makes the positioning for regional anesthesia a challenge. Systemic administration of analgesics can have adverse effects. Individually, both the fascia iliaca block (FIB) and femoral nerve blocks (FNB) have been studied. However, there is little evidence comparing the two. The aim of this study was to compare the overall efficacy of the two blocks in patients with proximal femur fracture before positioning for spinal anesthesia. Methods: ASA (American Society of Anesthesiologists) class I, II, and III patients scheduled for elective and emergency surgery with the diagnosis of proximal femur fracture between October 2018 and June 2019 were included in the study. The patients were assigned to two groups by convenience nonprobability sampling of 35 each. Results: Our study showed a reduction in visual analogue scale scores at 3, 4, and 5 minutes after administration of the FIB being 5.1 ± 1.1, 4.1 ± 1.3, and 2.8 ± 0.8, and those after the FNB as 4.4 ± 1.1, 3.3 ± 1.1, and 2.1 ± 1.4 with P < 0.05, which was statistically significant. The mean first rescue analgesia time for the FIB was 7.1 ± 2.1 hours, while for the FNB it was 5.2 ± 0.7 hours. The P value was less than 0.001, which was significant. Conclusions: Both ultrasound guided FNB and FIB techniques provide sufficient analgesia for patient's positioning before spinal anesthesia. However, the duration of postoperative analgesia provided by FIB was greater than that of the FNB.

키워드

참고문헌

  1. Fujihara Y, Fukunishi S, Nishio S, Miura J, Koyanagi S, Yoshiya S. Fascia iliaca compartment block: its efficacy in pain control for patients with proximal femoral fracture. J Orthop Sci 2013; 18: 793-7. https://doi.org/10.1007/s00776-013-0417-y
  2. Gupta N, Jain P, Kapadia M, Sanwatsarkar S, Saxena D, Maheshwari M. The effect of 0.25% levobupivacaine and 0.25% ropivacaine in fascia iliaca block in elderly patients with fracture femur given before positioning for subarachnoid block. Int J Res Med Sci 2018; 6: 191-4. https://doi.org/10.18203/2320-6012.ijrms20175718
  3. Rowlands M, Walt GV, Bradley J, Mannings A, Armstrong S, Bedforth N, et al. Femoral nerve block intervention in neck of femur fracture (FINOF): a randomised controlled trial. BMJ Open 2018; 8: e019650. https://doi.org/10.1136/bmjopen-2017-019650
  4. Iamaroon A, Raksakietisak M, Halilamien P, Hongsawad J, Boonsararuxsapong K. Femoral nerve block versus fentanyl: analgesia for positioning patients with fractured femur. Local Reg Anesth 2010; 3: 21-6.
  5. Yezierski RP. The effects of age on pain sensitivity: preclinical studies. Pain Med 2012; 13 Suppl 2: S27-36. https://doi.org/10.1111/j.1526-4637.2011.01311.x
  6. Sia S, Pelusio F, Barbagli R, Rivituso C. Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl. Anesth Analg 2004; 99: 1221-4. https://doi.org/10.1213/01.ANE.0000134812.00471.44
  7. Sharrock NE. Inadvertent "3-in-1 block" following injection of the lateral cutaneous nerve of the thigh. Anesth Analg 1980; 59: 887-8. https://doi.org/10.1213/00000539-198011000-00015
  8. Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia: the "3-in-1 block". Anesth Analg 1973; 52: 989-96.
  9. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, et al. Randomised trial of the fascia iliaca block versus the '3-in-1' block for femoral neck fractures in the emergency department. Emerg Med J 2015; 32: 685-9. https://doi.org/10.1136/emermed-2013-203407
  10. Salinas FV. Ultrasound and review of evidence for lower extremity peripheral nerve blocks. Reg Anesth Pain Med 2010; 35(2 Suppl): S16-25. https://doi.org/10.1097/AAP.0b013e3181d245df
  11. Cooper AL, Nagree Y, Goudie A, Watson PR, Arendts G. Ultrasound-guided femoral nerve blocks are not superior to ultrasound-guided fascia iliaca blocks for fractured neck of femur. Emerg Med Australas 2019; 31: 393-8. https://doi.org/10.1111/1742-6723.13172
  12. Reid N, Stella J, Ryan M, Ragg M. Use of ultrasound to facilitate accurate femoral nerve block in the emergency department. Emerg Med Australas 2009; 21: 124-30. https://doi.org/10.1111/j.1742-6723.2009.01163.x
  13. Yun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH. Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block. Acta Anaesthesiol Scand 2009; 53: 1282-7. https://doi.org/10.1111/j.1399-6576.2009.02052.x
  14. Williams H, Paringe V, Shenoy S, Michaels P, Ramesh B. Standard preoperative analgesia with or without fascia iliaca compartment block for femoral neck fractures. J Orthop Surg (Hong Kong) 2016; 24: 31-5. https://doi.org/10.1177/230949901602400109
  15. Groot L, Dijksman LM, Simons MP, Zwartsenburg MM, Rebel JR. Single fascia iliaca compartment block is safe and effective for emergency pain relief in hip-fracture patients. West J Emerg Med 2015; 16: 1188-93. https://doi.org/10.5811/westjem.2015.10.28270
  16. Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med 2003; 41: 227-33. https://doi.org/10.1067/mem.2003.51
  17. Callear J, Shah K. Analgesia in hip fractures. Do fascia-iliac blocks make any difference? BMJ Qual Improv Rep 2016; 5: u210130.w4147.
  18. Kumar D, Hooda S, Kiran S, Devi J. Analgesic efficacy of ultrasound guided FICB in patients with hip fracture. J Clin Diagn Res 2016; 10: UC13-6.
  19. Ghimire A, Bhattarai B, Koirala S, Subedi A. Analgesia before performing subarachnoid block in the sitting position in patients with proximal femoral fracture: a comparison between fascia iliaca block and femoral nerve block. Kathmandu Univ Med J (KUMJ) 2015; 13: 152-5. https://doi.org/10.3126/kumj.v13i2.16789
  20. Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubenovitch J, d'Athis F. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg 1998; 86: 1039-44. https://doi.org/10.1213/00000539-199805000-00025
  21. Newman B, McCarthy L, Thomas PW, May P, Layzell M, Horn K. A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. Anaesthesia 2013; 68: 899-903. https://doi.org/10.1111/anae.12321
  22. Mather LE, Long GJ, Thomas J. The intravenous toxicity and clearance of bupivacaine in man. Clin Pharmacol Ther 1971; 12: 935-43. https://doi.org/10.1002/cpt1971126935