Intravenous analgesia with opioids versus femoral nerve block with 0.2% ropivacaine as preemptive analgesic for fracture femur: A randomized comparative study

Abstract

Background and Objective:Femoral fractures are extremely painful and pain invariably worsens on any movement. Anesthesia for fracture femur surgery is usually provided by spinal block. This study was undertaken to compare the analgesic effects of femoral nerve block (FNB) using nerve stimulator with 0.2% ropivacaine (15 ml) and intravenous (I.V.) fentanyl before patient positioning for fracture femur surgery under spinal anesthesia.Materials and Methods:A prospective, randomized, double-blind, comparative study was conducted on 60 American Society of Anesthesiologists I and II patients (18–60 years) scheduled for femur surgery under combined spinal epidural anesthesia. Patients in Group I (n = 30), were administered FNB using nerve stimulator with 0.2% ropivacaine (15 ml) and in Group II patients (n = 30), I.V. fentanyl 0.5 μg/kg was given as preemptive analgesia. Parameters observed included time to spinal anesthesia, intra-operative and postoperative visual analog scale (VAS) for any pain and postoperative epidural top-ups dosages.Results:Demographic profile was comparable in both the groups. VAS at 2 min in Group I was 5.63 and in Group II it was 8.00. Satisfaction score was better in Group I as compared to Group II patients. Time to administer subarachnoid block was 17.80 min in patients of Group I as compared to 25.03 min in Group II patients. Postoperatively, VAS scores were lower in Group I than Group II patients. The frequency of epidural top-ups was higher in Group II than in Group I patients.Conclusions:FNB is comparatively better in comparison to I.V. fentanyl when used as preemptive and postoperative analgesic in patients being operated for fracture femur.

Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

“…Full-text articles were excluded with no comparison (n = 4), no comparison of interest (n = 6), different interventions (n = 9), no relevant outcome measure (n = 12), and review articles (n = 4). Ten studies [10][11][12][13][14][15][16][17][18][19] were ultimately included for qualitative and quantitative synthesis. single centers in Italy [16], Ireland [18], Pakistan [10], India [12,13,15,17,19], Nepal [14], and Thailand [11].…”

“…Two [10,12] of the studies recruited a majority of females for FNB. Four [11,15,17,19] studies recruited equal numbers of the two sexes, and one [13] study provided no information on sex. Three trials [10,11,16] reported the time from trauma to surgery, and averages ranged from 2.3-15.6 days.…”

“…For the method of FNB, time from the intervention to SA varied from 5 to 30 min. Most studies used the landmark method [10][11][12][13][15][16][17][18][19] or a stimulator [11][12][13][14][15][16][17][18][19] to perform FNB. The doses and types of local anesthetics were different.…”

“…Increasing numbers of published studies compared FNB to IVA with femur fractures for positioning for SA [10][11][12][13][14][15][16][17][18][19]. But this evidence is not well-integrated.…”

“…Tables 1 and S2 show the characteristics of the included studies. Eight studies [10][11][12][14][15][16][17][18] were RCTs, and two studies [13,19] observational studies. These studies were performed in Positioning of femur fracture patients for spinal block PLOS ONE | https://doi.…”