Abstract

Hip fractures are common in elderly and are usually managed by proximal femoral nailing (PFN) surgery. Fascia iliaca compartment block (FICB) is commonly administered to manage postoperative pain. The present study was aimed to compare duration of analgesia between suprainguinal and infrainguinal approach for FICB. Patients and methods: 80 geriatric patients undergoing elective PFN surgery under spinal anaesthesia were included in the study. At the end of surgery ultrasound guided FICB was administered. Patients were divided in to two groups, group SIFICB received FICB using suprainguinal approach and group IIFICB received FICB using infrainguinal approach. 40 ml of 0.125% levobupivacaine was injected below fascia iliaca. Postoperative pain was assessed using visual analogue scale (VAS) score at 2,4,6,8,12,16,20, and 24 hours. When VAS score was 4 or more, rescue analgesia (inj.Tramadol 1 mg/kg IV) along with inj. Ondansetron 4mg IV was administered. Postoperatively haemodynamic parameters were assessed at 2,4,6,8,12,16,20, and 24 hours. Any adverse effects such as delirium, nausea and vomiting were noted. Results: The duration of analgesia was significantly prolonged in group SIFICB when compared to group IIFICB (11.58±3.2 hrs vs 8.2±2.5 hrs, p< 0.0001). 24 hours tramadol requirement was significantly less in SIFICB group in comparison to IIFICB group (62.6±12.8 mg vs 87.4±14.6 mg, p<0.0001). VAS scores were significantly lower in SIFICB group at 12 and 16 hours postoperatively in comparison to IIFICB group (p<0.0001). Conclusion: Suprainguinal FICB is preferred to infrainguinal FICB in geriatric patients undergoing PFN surgery as it provides longer duration of analgesia, decreases postoperative tramadol requirement, and decreases postoperative VAS score.

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