The effect of 0.25% levobupivacaine and 0.25% ropivacaine in fascia iliaca block in elderly patients with fracture femur given before positioning for subarachnoid block

Abstract

Background: Positioning of elderly patients with fracture femur for subarachnoid block (SAB) is a challenging task, both for the patient and anesthesiologist. Severe pain not only adds to the morbidity but also alters the success rate of SAB as appropriate positioning becomes difficult. Fascia iliaca compartment block (FICB) is a simple, rapid, effective and safe method for achieving excellent pain relief. The purpose of this study is to compare the efficacy of 0 .25% of levobupivacaine and 0.25% ropivacaine in FICB on reducing preoperative and postoperative pain and analgesic consumption in lower limb surgery.Methods: 60 elderly patients of ASA class I-III scheduled for elective fracture femur surgery were enrolled in the study and randomly divided into two groups. Group L received 30ml 0.25% levobupivacaine in FICB while Group R received 0.25% ropivacaine in FICB 15min before SAB. Parameters recorded were blood pressure, heart rate, visual analogous scale (VAS), quality of positioning and time to first rescue analgesia. VAS was noted before and after performing FICB and at the time of positioning for subarachnoid block (SAB).Results: The VAS score at different time interval and time to first rescue analgesia were comparable (P >0.05). Quality of positioning was also similar in both the groups (P >0.05).Conclusions: The study demonstrates that levobupivacaine and ropivacaine produce comparable preoperative and postoperative analgesia when used for FICB.

Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: an observational study

“…The fractures of the proximal femur, including the fracture of the neck of femur, intertrochanteric, and subtrochanteric fractures, are a common orthopedic emergency, especially in the geriatric population [1]. These fractures are extremely painful and associated with significant morbidity and mortality [2,3]. Regional anesthesia is preferred during surgery in these patients.…”

Effect of Dexmedetomidine on Levobupivacaine and Ropivacaine in Fascia Iliaca Block for Trochanteric Fractures Treated by Proximal Femoral Nail – A Randomized Trial

“…They found that the DOA is similar in both the groups and the difference is statistically insignificant (572.0 ± 269.2 vs. 534.55 ± 166.90 minutes). However, they did not study the total consumption of analgesic in the two groups [5]. In our groups, the DOA is found to be longer as we added dexmedetomidine.…”

“…Successful pain management enhances early ambulation and reduces hospital stay [4]. Researchers have been trying a variety of drugs and their combinations in FIB [5]. Local anesthesia (LA) drugs such as bupivacaine, levobupivacaine, and ropivacaine are the most commonly used analgesics for this block.…”

“…Local anesthesia (LA) drugs such as bupivacaine, levobupivacaine, and ropivacaine are the most commonly used analgesics for this block. Being a pure sensory block, a lower concentration of LA, i.e., 0.25%, has been found to be effective [5]. Numerous adjuvants (opioid, dexamethasone, α-adrenergic agonists such as clonidine, dexmedetomidine) are being tested to enhance the duration and reduce the onset time of blocks [6].…”