Comparison of Pre-Operative Ultrasound Guided Fascia Iliaca Block and Quadratus Lumborum Block for Reduction of Pain During Positioning for Spinal Anaesthesia and Post-Operative Analgesia in Patients with Femoral Neck Fracture

Abstract

Background and aims Fascia iliaca block FIB provides analgesia in lower limb surgeries. However efficacy of quadratus lumborum block QLB for post-operative analgesia in lower limb surgeries is less explored. The present study was designed to compare efficacy of QLB with FIB to facilitate positioning for spinal anaesthesia SAB and post-operative analgesia in patients with femoral neck fracture.Methods Fifty patients were assigned to one of the two groups group A receiving FIB n25 and group B receiving QLB n25. Both the groups received bupivacaine 0.125 30 mL 20 minutes before SAB. Visual analogue pain scale VAS after block during positioning for spinal anaesthesia and during post-operative period were recorded. SAB was administered with 0.5 heavy bupivacaine 10 mg. Post-operative duration of analgesia and rescue analgesics required for 24 hours were recorded. Statistical evaluation of data was done using IBM SPSS version 22 software. Quantitative data was assessed by Shapiro Wilk test Chi-square Fisher Exact test Student t test Mann Whitney U test. Paired t test was used for intra group comparison. Appropriate tests were applied p value lt 0.05 was considered as statistically significant.Results Demographic parameters were comparable. VAS scores at baseline and 20 minutes after block and duration of analgesia were comparable. The requirement of rescue analgesia PCT in the post-operative period for 24 hours was 2666.66plusmn866 mg in group-A and group-B required 3111.11plusmn600.9 mg p0.22 and second rescue analgesic tramadol in group-A and B were comparable p0.34. But reduction in VAS score at the time of positioning for SAB was higher in group-B p0.003 Group-A 5.66 plusmn 0.86 Group-B 6.55plusmn1.13. No significant side effects were noted in both the groups.Conclusion QLB was associated with marginally better reduction in pre-operative pain compared to FIB during positioning for spinal anesthesia but did not prolong duration of post-operative analgesia or decrease the analgesia requirement.