Abstract
Background
Patient positioning for performing spinal blockade causes severe pain in hip and femur fracture. Adequate pain relief before administrating spinal blockade will increase patient’s cooperation. This study was done to assess analgesic effect of fascia iliaca compartment block (FICB) for positioning for spinal anesthesia.
Materials and Methods
This was a randomized, double blind, controlled prospective study that included 100 patients of the American Society of Anesthesiologists physical statuses I to III, of either sex, between 30 and 90 years, posted for hip or proximal femoral surgery, with visual analogue scale (VAS) >3 in preoperative period. The two groups were assigned randomly. In Group 1, FICB was given half an hour before shifting the patients in operation theater with 30 ml of 0.25% ropivacaine, and in Group 2, sham block was given with 30 ml normal saline. Each group included 50 patients. Thirty minutes after FICB, spinal anesthesia was given and patients’ vitals were monitored before and after block, at the time of positioning for spinal anesthesia, intraoperative and postoperative periods.
Results
In Group 1, mean VAS before FICB was 8.02 which reduced to 2.28, which is statistically significant (P = 7.8813E-50), whereas in Group 2, mean VAS before sham block was 7.98 which reduced to 7.90, which is statistically nonsignificant (P = 0.6694). Mean total duration of analgesia in Group 1 was 428.3 min after spinal anesthesia, whereas in Group 2, mean total duration of analgesia was 240.1 min.
Conclusion
FICB effectively provides analgesia for positioning for spinal anesthesia to patients in hip and proximal femur surgeries. It also provides analgesia in postoperative period without having significant alteration in the hemodynamic profile of patients.
Similar content being viewed by others
References
Cervero F, Laird JM. One pain or many pains? A new look at pain mechanisms. NIPS 1991;6:268–73.
Melzack R, Wall PD. On the nature of cutaneous sensory mechanisms. Brain 1962;85:331–56.
Kennedy RM, Luhmann JD, Luhmann SJ. Emergency department management of pain and anxiety related to orthopedic fracture care: A guide to analgesic techniques and procedural sedation in children. Paediatr Drugs 2004;6:11–31.
Berry FR. Analgesia in patients with fractured shaft of femur. Anesthesia 1977;32:576–7.
Tam CW, Rainer TH. Femoral nerve block for pain management of femoral fractures in the emergency department: Evidence based topic review. Hong Kong J Emerg Med. 2005;12(3):178–81.
McGlone R, Sadhra K, Hamer DW, Pritty PE. Femoral nerve block in the initial management of femoral shaft fractures. Arch Emerg Med 1987;4:163–8.
Helayel PE, Lobo G, Vergara R, Conceição DB, Oliveira Filho GR. Effective volume of local anesthetics for fascia iliac compartment block: A double-blind, comparative study between 0.5% ropivacaine and 0.5% bupivacaine. Rev Bras Anestesiol 2006;56:454–60.
Paria R, Surroy S, Majumder M, Paria B, Sengupta S, Das G, et al. Combination of fascia iliaca compartment block on the surgical side with sacral spinal anesthesia for hip to knee surgery. IOSR J Dent Med Sci 2014;13:46–9.
Petsas D, Griffiths R. Fascia iliaca block (FIB) in elderly patients outside the operating room for pain management of proximal femur fractures. Greek E J Perioper Med 2014;12:2–12.
Moore KL, Dalley AF. Clinically Oriented Anatomy. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 566.
Jadon A, Kedia SK, Dixit S, Chakraborty S. Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture. Indian J Anaesth 2014;58:705–8.
Foss NB, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: A randomized, placebo-controlled trial. Anesthesiology 2007;106:773–8.
Godoy Monzon D, Iserson KV, Vazquez JA. Single fascia iliaca compartment block for post-hip fracture pain relief. J Emerg Med 2007;32:257–62.
Godoy Monzón D, Vazquez J, Jauregui JR, Iserson KV. Pain treatment in posttraumatic hip fracture in the elderly: Regional block vs. systemic non-steroidal analgesics. Int J Emerg Med 2010;3:321–5.
Watters CL, Moran WP. Hip fractures — A joint effort. Orthop Nurs 2006;25:157–65.
Dulaney-Cripe E, Hadaway S, Bauman R, Trame C, Smith C, Sillaman B, et al. A continuous infusion fascia iliaca compartment block in hip fracture patients: A pilot study. J Clin Med Res 2012;4:45–8.
Yun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH. Analgesia before a spinal block for femoral neck fracture: Fascia iliaca compartment block. Acta Anaesthesiol Scand 2009;53:1282–7.
Elkhodair S, Mortazavi J, Chester A, Pereira M. Single fascia iliaca compartment block for pain relief in patients with fractured neck of femur in the emergency department: A pilot study. Eur J Emerg Med 2011;18:340–3.
Fujihara Y, Fukunishi S, Nishio S, Miura J, Koyanagi S, Yoshiya S. Fascia iliaca compartment block: Its efficacy in pain control for patients with proximal femoral fracture. J Orthop Sci 2013;18:793–7.
Morrison RS, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ, et al. The impact of postoperative pain on outcomes following hip fracture. Pain 2003;103:303–11.
Stevens M, Harrison G, McGrail M. A modified fascia iliaca compartment block has significant morphine-sparing effect after total hip arthroplasty. Anaesth Intensive Care 2007;35:949–52.
Anaraki AN, Mirzaei K. The effect of fascia iliaca compartment block versus gabapentin on postoperative pain and morphine consumption in femoral surgery, a prospective, randomized, double-blind study. Indian J Pain 2014;28:111–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kacha, N.J., Jadeja, C.A., Patel, P.J. et al. Comparative Study for Evaluating Efficacy of Fascia Iliaca Compartment Block for Alleviating Pain of Positioning for Spinal Anesthesia in Patients with Hip and Proximal Femur Fractures. IJOO 52, 147–153 (2018). https://doi.org/10.4103/ortho.IJOrtho_298_16
Published:
Issue Date:
DOI: https://doi.org/10.4103/ortho.IJOrtho_298_16