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.

Abstract

Positioning for subarachnoid block (SAB) in patients with femoral fracture is painful and may remain suboptimal requiring use of large doses of opioids. These patients generally being elderly with multiple comorbidities and frailty are likely to have many undesirable effects of opioids including respiratory depression and confusion. The objective was to compare the feasibility and effectiveness of fascia iliaca compartment block (FICB) and femoral nerve block (FNB) in reducing pain associated with positioning for subarachnoid block in patients undergoing proximal femoral fracture fixation procedures. Group FICB patients (n=15) received fascia iliaca block with 30 ml of 1.5% lignocaine with adrenaline and group FNB patients (n=15) received femoral nerve block with 15 ml of 1.5% lignocaine with adrenaline. After the study blocks, patients were kept on supine position for at least 20 minutes before shifting them to the operation theatre. Pain was assessed by using visual analog scale values before the block and during the position for subarachnoid block. Time to perform subarachnoid block, quality of positioning and acceptance was recorded. Visual analog scale values during positioning for SAB were lower in FIB group than in FNB (1.0±1.1 versus 2.1±0.8; P< 0.05). Time to perform SAB was shorter in FIB than in FNB (109.6±28.2 seconds versus 134.8±31.9 seconds; P< 0.05). Quality of patient positioning for SAB was comparable between the groups. Patient acceptance was less in group FNB (P< 0.05). Fascia iliaca compartment block provides better analgesia than femoral nerve block in terms of facilitating optimal positioning for subarachnoid block in patients undergoing proximal femoral fracture fixation procedure.