Background
Ultrasound (US)-guided quadratus lumborum block (QLB) and transversus abdominis plane block (TAP) are used as a part of multimodal analgesia for postoperative pain after abdominal procedures, as they improve postoperative pain.
Results
QLB group showed significantly better visual analog score (VAS) scores from 6 h till 24 h postoperative. Time for the first request for pethidine was significantly longer in the QLB group (398.3 ± 23.7 min) than in the TAP group (80.3 ± 20.7 min), (p < 0.0001 and its total consumption was significantly lesser (p = 0.007) in the QLB group (68.33 ± 66.28) than in TAP group (120.0 ± 76.11). Also, the sensory level was higher in the QLB group (8.3 ± 0.63 segments) than in the TAP group (6.2 ± 0.79 segments), (p < 0.001). Moreover, only 2 patients (6.67%) in the QLB group experienced nausea and/or vomiting versus 9 (30%) in TAP group with significant value.
Conclusions
QLB was more effective in providing visceral and somatic pain analgesia after total abdominal hysterectomy (TAH) in comparison to TAP block, QLB resulted in wider sensory blockade compared to TAP block with less incidence of postoperative nausea and/or vomiting.
Background & objective: Spinal anesthesia (SA) is preferred for fractured femur surgery but it requires proper positioning which is often very difficult to achieve due to pain. Different methods have been used to control the pain during patient positioning, but the results are inconsistent about the superiority of one over the other. We compared femoral nerve block (FNB) and intravenous ketamine for pain control during positioning for SA in elderly patients with femur fracture.
Methodology: A total of 66 patients above 60 y of age were randomly divided into two equal groups; FNB group to receive ultrasound guided FNB with 15-20 ml of bupivacaine 0.25% and ketamine group to receive IV ketamine 0.25 mg/kg. Assessment of VAS scores during positioning before SA was done. Rescue analgesia for pain during positioning was achieved by inj fentanyl IV, and after the surgery by inj morphine IV. Postoperative VAS scores, calculation of total morphine consumption during the first 24 h and any complications were recorded.
Results: The VAS score during positioning was lower in FNB group compared to ketamine group (P < 0.001). This was evident by lower recorded doses of pre-spinal rescue fentanyl. FNB group showed better postoperative analgesia, less morphine consumption and less complications.
Conclusion: FNB provided better analgesia during positioning for spinal blockade in fractured femur patients. Furthermore, FNB was associated with less adverse effects, better postoperative analgesia and less opioid consumption.
Trial Registry: PACTR202112605652525.
Abbreviations: SA - Spinal anesthesia; FNB - Femoral nerve block; NSAIDS - Nonsteroidal anti-inflammatory drugs; VAS - Visual Analog Scale
Key words: Pain; Spinal anesthesia; Femoral nerve block; Ketamine; Femur surgery
Citation: Moussa MEM, Awad HGS, Hamid HSA, Abdellatif AE, Sharaf AGS. A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture. Anaesth. pain intensive care 2022;26(3):297-303.
DOI: 10.35975/apic.v26i3.1895
Received: January 25, 2022, Reviewed: March 16, 2022, Accepted: March 23, 2022
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