Korean J Pain.  2020 Apr;33(2):138-143. 10.3344/kjp.2020.33.2.138.

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

• Gupta M
• Kamath SS

• KMID: 2502637
• DOI: http://doi.org/10.3344/kjp.2020.33.2.138

Abstract

Background
Severe pain associated with proximal femur fractures makes the positioning for regional anesthesia a challenge. Systemic administration of analgesics can have adverse effects. Individually, both the fascia iliaca block (FIB) and femoral nerve blocks (FNB) have been studied. However, there is little evidence comparing the two. The aim of this study was to compare the overall efficacy of the two blocks in patients with proximal femur fracture before positioning for spinal anesthesia.
Methods
ASA (American Society of Anesthesiologists) class I, II, and III patients scheduled for elective and emergency surgery with the diagnosis of proximal femur fracture between October 2018 and June 2019 were included in the study. The patients were assigned to two groups by convenience nonprobability sampling of 35 each.
Results
Our study showed a reduction in visual analogue scale scores at 3, 4, and 5 minutes after administration of the FIB being 5.1 ± 1.1, 4.1 ± 1.3, and 2.8 ± 0.8, and those after the FNB as 4.4 ± 1.1, 3.3 ± 1.1, and 2.1 ± 1.4 with P < 0.05, which was statistically significant. The mean first rescue analgesia time for the FIB was 7.1 ± 2.1 hours, while for the FNB it was 5.2 ± 0.7 hours. The P value was less than 0.001, which was significant.
Conclusions
Both ultrasound guided FNB and FIB techniques provide sufficient analgesia for patient’s positioning before spinal anesthesia. However, the duration of postoperative analgesia provided by FIB was greater than that of the FNB.

Keyword

Analgesics; Anesthesia, Spinal; Bupivacaine; Fascia; Femoral Nerve; Fractures, Bone; Nerve Block; Pain Management; Ultrasonography

Figure

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  Fig. 1 Preoperative mean visual analogue scale (VAS) score. FIB: fascia iliaca block, FNB: femoral nerve block.

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  Fig. 2 Intra operative and postoperative heart rate. FIB: fascia iliaca block, FNB: femoral nerve block.

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  Fig. 3 Intra operative and postoperative mean arterial pressure. FIB: fascia iliaca block, FNB: femoral nerve block.

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  Fig. 4 First analgesia request time. FIB: fascia iliaca block, FNB: femoral nerve block.

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  Fig. 5 Total amount of analgesia required in 24 hours. FIB: fascia iliaca block, FNB: femoral nerve block.

Reference

1. Fujihara Y, Fukunishi S, Nishio S, Miura J, Koyanagi S, Yoshiya S. 2013; Fascia iliaca compartment block: its efficacy in pain control for patients with proximal femoral fracture. J Orthop Sci. 18:793–7. DOI: 10.1007/s00776-013-0417-y. PMID: 23744530.

2. Gupta N, Jain P, Kapadia M, Sanwatsarkar S, Saxena D, Maheshwari M. 2018; 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. Int J Res Med Sci. 6:191–4. DOI: 10.18203/2320-6012.ijrms20175718.

3. Rowlands M, Walt GV, Bradley J, Mannings A, Armstrong S, Bedforth N, et al. 2018; Femoral nerve block intervention in neck of femur fracture (FINOF): a randomised controlled trial. BMJ Open. 8:e019650. DOI: 10.1136/bmjopen-2017-019650. PMID: 29643155. PMCID: PMC5900449.

4. Iamaroon A, Raksakietisak M, Halilamien P, Hongsawad J, Boonsararuxsapong K. 2010; Femoral nerve block versus fentanyl: analgesia for positioning patients with fractured femur. Local Reg Anesth. 3:21–6. DOI: 10.2147/LRA.S8600. PMID: 22915864. PMCID: PMC3417943.

5. Yezierski RP. 2012; The effects of age on pain sensitivity: preclinical studies. Pain Med. 13(Suppl 2):S27–36. DOI: 10.1111/j.1526-4637.2011.01311.x. PMID: 22497745. PMCID: PMC3565621.

6. Sia S, Pelusio F, Barbagli R, Rivituso C. 2004; Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl. Anesth Analg. 99:1221–4. DOI: 10.1213/01.ANE.0000134812.00471.44. PMID: 15385380.

7. Sharrock NE. 1980; Inadvertent “3-in-1 block” following injection of the lateral cutaneous nerve of the thigh. Anesth Analg. 59:887–8. DOI: 10.1213/00000539-198011000-00015. PMID: 7191678.

8. Winnie AP, Ramamurthy S, Durrani Z. 1973; The inguinal paravascular technic of lumbar plexus anesthesia: the “3-in-1 block”. Anesth Analg. 52:989–96. DOI: 10.1213/00000539-197311000-00036. PMID: 4796576.

9. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, et al. 2015; Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 32:685–9. DOI: 10.1136/emermed-2013-203407. PMID: 25430915.

10. Salinas FV. 2010; Ultrasound and review of evidence for lower extremity peripheral nerve blocks. Reg Anesth Pain Med. 35(2 Suppl):S16–25. DOI: 10.1097/AAP.0b013e3181d245df. PMID: 20216021.

11. Cooper AL, Nagree Y, Goudie A, Watson PR, Arendts G. 2019; Ultrasound-guided femoral nerve blocks are not superior to ultrasound-guided fascia iliaca blocks for fractured neck of femur. Emerg Med Australas. 31:393–8. DOI: 10.1111/1742-6723.13172. PMID: 30198199.

12. Reid N, Stella J, Ryan M, Ragg M. 2009; Use of ultrasound to facilitate accurate femoral nerve block in the emergency department. Emerg Med Australas. 21:124–30. DOI: 10.1111/j.1742-6723.2009.01163.x. PMID: 19422409.

13. Yun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH. 2009; Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block. Acta Anaesthesiol Scand. 53:1282–7. DOI: 10.1111/j.1399-6576.2009.02052.x. PMID: 19650803.

14. Williams H, Paringe V, Shenoy S, Michaels P, Ramesh B. 2016; Standard preoperative analgesia with or without fascia iliaca compartment block for femoral neck fractures. J Orthop Surg (Hong Kong). 24:31–5. DOI: 10.1177/230949901602400109. PMID: 27122509.

15. Groot L, Dijksman LM, Simons MP, Zwartsenburg MM, Rebel JR. 2015; Single fascia iliaca compartment block is safe and effective for emergency pain relief in hip-fracture patients. West J Emerg Med. 16:1188–93. DOI: 10.5811/westjem.2015.10.28270. PMID: 26759680. PMCID: PMC4703160.

16. Fletcher AK, Rigby AS, Heyes FL. 2003; Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 41:227–33. DOI: 10.1067/mem.2003.51. PMID: 12548273.

17. Callear J, Shah K. 2016; Analgesia in hip fractures. Do fascia-iliac blocks make any difference? BMJ Qual Improv Rep. 5:u210130.w4147. DOI: 10.1136/bmjquality.u210130.w4147. PMID: 26893899. PMCID: PMC4752715.

18. Kumar D, Hooda S, Kiran S, Devi J. 2016; Analgesic efficacy of ultrasound guided FICB in patients with hip fracture. J Clin Diagn Res. 10:UC13–6. DOI: 10.7860/JCDR/2016/17802.8123. PMID: 27630930. PMCID: PMC5020165.

19. Ghimire A, Bhattarai B, Koirala S, Subedi A. 2015; Analgesia before performing subarachnoid block in the sitting position in patients with proximal femoral fracture: a comparison between fascia iliaca block and femoral nerve block. Kathmandu Univ Med J (KUMJ). 13:152–5. DOI: 10.3126/kumj.v13i2.16789. PMID: 26643833.

20. Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubenovitch J, d’Athis F. 1998; Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg. 86:1039–44. DOI: 10.1213/00000539-199805000-00025. PMID: 9585293.

21. Newman B, McCarthy L, Thomas PW, May P, Layzell M, Horn K. 2013; A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. Anaesthesia. 68:899–903. DOI: 10.1111/anae.12321. PMID: 23789738.

22. Mather LE, Long GJ, Thomas J. 1971; The intravenous toxicity and clearance of bupivacaine in man. Clin Pharmacol Ther. 12:935–43. DOI: 10.1002/cpt1971126935. PMID: 5134997.