USG Guided Femoral Nerve Block And Lateral Femoral Cutaneous Nerve Block To Provide Analgesia For Positioning Of Patients With Intertrochanteric Fracture Femur Before Subarachnoid Block

Abstract

Background: Femoral fractures are one of the most common fractures represented with an annual prevalence of around 2.9 million cases worldwide. Intertrochanteric fractures of femur subject the patients to lot of pain due to overriding of fracture ends especially during patient positioning for subarachnoid block. A central neuraxial block, mainly subarachnoid block is commonly used for surgery of Intertrochanteric fractures of femur.
Aim: Our aim was to assess the effectiveness of ultrasound (USG) guided femoral nerve block
(FNB) and lateral femoral cutaneous nerve block (LFNB) before positioning for subarachnoid block for intertrochanteric fracture femur and to assess the VAS up to 24 hrs after surgery.
Methods: It was a prospective observational study conducted at Bone and Joint Hospital which is one of the associated hospitals of Government Medical College Srinagar in the department of anaesthesiology on 200 patients of ASA I and II class of age group (20 - 70 years) old, posted for intertrochanteric fracture femur surgeries under spinal anaesthesia. Patients were randomized into two groups Group A (N = 100) received USG guided femoral nerve block and lateral femoral cutaneous nerve block before positioning for spinal anaesthesia with 0.2 % ropivacaine and in control Group B (N = 100) didn’t receive any interventions preoperatively. Parameters recorded included VAS at baseline, 10 mins and during positioning, anaesthesiologist’s satisfaction (yes or no), total Tramadol consumption and patient’s satisfaction (Likert scale).
Results: Demographic variables were comparable in both groups. Mean pain intensity in the VAS score at the time of admission to the operating room was 6.9±0.9, which was reduced to 2.7±0.9 after blockade. In this study, 74 (74%) patients were very satisfied (Likert scale 5), 18 (18%) were satisfied (Likert scale 4), 4 (4%) had no opinion (Likert scale 3), 4 (4%) were not satisfied (Likert scale 2), and no one was dissatisfied (Likert scale 1). VAS in Group A 10 mins and during positioning was 2.5 ± 1.09 and 3.2 ± 0.31 in comparison to 6.56 ± 0.67 and 7.4 ± 0.82 in control group B respectively. Only 10 patients required injection tramadol and total consumption was 45±30 mg in group A, while all patients in control group required injection tramadol and total consumption was 170±70 mg. Anaesthesiologists and patient’s satisfaction were much higher in Group A. 

Conclusion: USG - guided femoral nerve block (FNB) and lateral femoral cutaneous nerve block (LFNB) before positioning for spinal anaesthesia for intertrochanteric fracture femur is very effective in controlling pain during positioning for spinal anaesthesia. This analgesia block is a safe and effective to be used for positioning prior to spinal anesthesia and it prolongs postoperative analgesia.