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Background and Aims Peripheral nerve blocks can serve as useful alternatives in cases where epidural analgesia is not feasible. This study was conducted to compare the postoperative analgesic efficacy of continuous suprainguinal fascia iliaca(SFICB), infrainguinal fascia iliaca(IFICB)and femoral nerve blocks(FNB) in patients being operated for proximal femur fractures.
Methods After written informed consent, this prospective, randomized, double-blind study was conducted in 60 patients scheduled to undergo proximal femur fracture fixation under general anesthesia. Patients were randomized to one of three groups of 20 patients each to receive either continuous FNB(Group F), IFICB(Group I) or SFICB(Group S).Prior to extubation, USG-guided continuous FNB, IFICB or SFICB was administered using 0.3ml/kg of 0.2% ropivacaine as a bolus followed by a continuous infusion of 10mL/h of 0.2% ropivacaine for 24hours via a catheter. All patients were assessed for severity of pain at 0, 2, 4, 8, 12 and 24hours. Patients with a VAS>4, were given intravenous morphine(0.05mg/kg). We recorded time to administration of first rescue analgesic and 24-hour morphine consumption.
Mean VAS score at different points of time (0,2,4,6,8,12 and 24 hrs) under three different groups F (FNB), S (SFICB) and I (IFICB)
Results The values of VAS score were significantly lower in patients with SFICB block versus patients with FNB and IFICB block at various time points during the 24-hour interval (figure 1). There was no difference in the time to administration of first dose of rescue analgesic (1.8+2.04hrs vs 3.10+5.93hrs vs 2.2+6.01hrs), however, there was a significant reduction in 24-hour rescue analgesia consumption in SFICB group compared to the other two groups(p<0.05).
Conclusions Continuous SFICB provided significantly better postoperative pain relief than FNB and IFICB in patients operated for proximal femur fractures.