Comparison of efficacy of magnesium sulphate and dexamethasone as adjuvants to ropivacaine in ultrasound guided Suprainguinal fascia Iliaca block administered before regional Anesthesia for patients undergoing proximal femur fracture surgeries

Abstract

Background and Aim: Fascia iliaca compartment block(FICB) provides excellent analgesia to patients with proximal femur fractures, especially required during positioning to regional anesthesia. Use of ultrasonography (USG) helps in direct visualisation of the anatomy and with suprainguinal approach single injection of drugs administered. We compared the efficacy of Magnesium sulphate (MgSO4) and Dexamethasone as additives to 0.2% ropivacaine for FICB for better pain relief and post op analgesia. Methods: This is a comparative, randomised, double blind, controlled prospective study included 50 patients with 18-90 years of age group, belonging to ASA I to III, undergoing proximal femur fracture surgeries. Patients were divided into two groups of 25 each. Group M (magnesium sulphate) patients received 0.2% ropivacaine 28ml with 2ml of 25% MgSo4 (500mg). Group D(dexamethasone) patients received 0.2% ropivacaine 28ml with 2ml of dexamethasone (8mg) for USG guided FICB. Time for onset of analgesia using numerical rating scale (NRS <5), time for complete analgesia (NRS is 0) on passive movement of the limb, duration of post op analgesia, patient satisfaction, ease of positioning were assessed for first 24 hrs. Descriptive and inferential statistical analysis has been carried out in the present study. Student t test has been used for quantitative data analysis. Chi square tesrt/ Fisher Exact test has been used for qualitative data analysis. Results: Time for onset of analgesia (NRS <5) was decreased with MgSO4 (P value < 0.001). Time for complete analgesia (NRS 0) was also decreased with MgSO4 (P value < 0.001). Post op analgesia was more with Dexamethasone group (P< 0.001). Patient satisfaction, and ease of positioning was good in both the groups. Conclusion: Addition of MgSO4 and Dexamethasone to Ropivacaine for FICB provides better analgesia coverage with MgSO4 reducing onset of analgesia and time for complete analgesia. Dexamethasone provides increased duration of analgesia.