Abstract
Introduction: Fracture of proximal femur is a common occurrence following road traffic accidents and falls (in relatively older age group). These fractures are associated with considerable pain before surgery and in postoperative period. Effective pain management during positioning and in postoperative period is crucial and fascia Iliaca compartment block can be used effectively for this purpose in these patients. Many adjuvants like epinephrine, clonidine, Opioids, ketamine, dexamethasone and dexmedetomidine were combined with local anaesthetics to prolong the post-operative analgesia. We conducted this prospective study to know duration of post-operative analgesia with Fascia iliaca compartment block (ficb) using Bupivacaine with Dexmedetomidine and Bupivacaine with Dexamethasone in patients with proximal fracture femur.
Materials and methods: This was a randomized, prospective, double blinded and controlled study done in the department of anesthesiology of a medical college situated in an urban area. 90 patients of either gender , ASA grade I & II ,the age of whom was between 18-80 years and who were undergoing surgery for proximal fracture femur under spinal anesthesia were enrolled in this study . All these patients received FICB by landmark technique before spinal anesthesia. The patients were divided in 3 groups. Group I - Patient in this group received 0.25% Bupivacaine plus normal saline 0.9%. Group II Patient in this group received 0.25% Bupivacaine plus dexamethasone. Group III Patient in this group received 0.25% Bupivacaine plus dexmedetomidine. Level of analgesia during positioning and in post operative period along with other parameters like sedation scores, VAS scores, hemodynamics and complications in these 3 groups were compared.
Results: The study comprised of 90 patients out of which 45 (50%) were males and 45 (50%) were females with a M: F ratio of 1:1. ASA Grades and Mean duration of surgeries in these groups were comparable. For preoperative Pulse Rate, SBP, SpO2 the test used was One-Way ANOVA. p > 0.05 for all three parameters. There was no significant difference in onset of FICB and time required for giving spinal anesthesia in three groups (p>0.05). 27(90%) patients in group I, 25(83%) patients in group II and 26(87%) patients in group III had no sensation to pinprick thirty minutes after FICB. Preoperative pulse rate and pulse rate thirty minutes after FICB were compared .There was significant reduction in pulse rate (p<0.05) in group III 30 minutes after FICB. The analysis of changes in mean pulse rates showed that there was no significant difference in mean pulse rate intraoperatively (p>0.05). the study of postoperative duration of analgesia showed that There was highly significant difference in post-operative duration of analgesia between group I&II ,group I&III and group II&III .
Conclusion: Addition of dexamethasone or dexmedetomidine to Bupivacaine for fascia iliaca compartment block in patients with proximal femur fracture further prolongs post-operative analgesia compared to plain Bupivacaine. Addition of dexmedetomidine to Bupivacaine provides better postoperative analgesia than Bupivacaine with dexamethasone.
