Abstract
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.
Highlights
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
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
Hemantkumar et al 2018[16] studied the patients who presented with the fracture of femoral shaft and neck in the emergency department were randomly divided into two groups of 30 patients each: group D (n = 30): patients were administered mL ropivacaine (0.5%) plus dexmedetomidine 1 μg/kg body weight and group R (n = 30): patients were administered 15 mL ropivacaine (0.5%) plus 1 mL saline the efficacy of dexmedetomidine added to ropivacaine in FNB with regard to onset, duration, efficacy of analgesia, and patient acceptance and concluded that the addition of dexmedetomidine to ropivacaine in FNB provides early onset of analgesia, prolongs the duration of analgesia, improves the quality of analgesia, and has better patient acceptance
Summary
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. [1] Pain management is an essential component of care provided by anaesthesiologists. Fascia iliaca blocks provide a safe, cheap and effective form of pain relief for patients with neck of femur fractures, and for those with femoral shaft fractures.[5,6]. Ropivacaine is a long-acting regional anaesthetic that is structurally related to Bupivacaine It is a pure S(-)enantiomer, unlike Bupivacaine, which is a racemate, developed for the purpose of reducing potential toxicity and improving relative sensory and motor block profiles.[7]. [15] In human beings, the beneficial effects of adding dexmedetomidine to local anesthetics during regional anesthesia and some peripheral nerve blockade procedures have proved to be efficacious for the surgical patients.[16,17,18] This peripheral nerve block in lower limb can be achieved by femoral nerve block alone or by 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 anaesthesia in femur fractures
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