Fracture of femur is a particularly painful bone injury because the periosteum has the lowest pain threshold of the deep somatic structures. Surgical repair most commonly involves either internal fixation of the fracture or replacement of the femoral head with arthroplasty. At our institution, spinal block was used more frequently than general anaesthesia (GA) for femoral fracture surgery. Correct positioning during central neuraxial block is the prerequisite for a successful procedure. However, limb immobility and extreme pain are the deterrents for an ideal positioning for this procedure. Various modalities like intravenous (IV) fentanyl (FENT), femoral nerve block (FNB) or fascia iliaca block with local anaesthetic have been advocated to reduce the pain pre-operatively and improve the positioning of these patients. There are few data to establish a benefit of one form of anaesthetic over another in this situation. This prospective study will be performed to compare the analgesic effects of FNB with intravenous (IV) fentanyl prior to positioning for spinal block in patients with fractured femur. AIM OF THE STUDY The present study is to compare the analgesic effect of femoral nerve block(FNB) with intravenous (IV) fentanyl prior to positioning patient with fracture femur for spinal block. PLACE OF WORK Department of anaesthesiology AIIMS Patna MATERIAL AND METHOD Material:- A. Patients B. Drugs C. Equipments A. Patients INCLUSION CRITERIA 1. Age 18 to 80 years 2. ASA I/II 3.Scheduled for fracture femur operation under central neuraxial block 4. Unable to sit due to pain EXCLUSION CRITERIA 1. ASA III or more 2. Multiple fractures 3. Patients who sit comfortably 4. Allergy to the drugs 5. Coagulopathy 6. Infection at puncture site 7. Mental disorder and Communication failure 8. Use of analgesia for premedication 9. Preexisting neurological disease like peripheral neuropathy B. Drugs Inj lignocaine 1.5% Inj Fentanyl Various i.v fluid All emergency drugs C. Equipments Anaesthesia machine Multi parameter monitor (NIBP, Pulse oxymetry, ECG) Suction apparatus, Laryngoscope, ET tube, All resuscitative equipment kept ready METHOD Informed consent will be taken for the study. The patient will be examined and evaluated on the day before surgery. They will be explained the procedure of anaesthesia to allay anxiety and apprehension. In this randomized prospective study 60 patients having fracture femur will be entered. Premedication such as oral benzodiazepines (alprazolam 0.25mg) will be given at bed time on the day before surgery. The patients will be allocated by computer-generated random numbers into two groups of 30 patients each: an FNB group and IV FENT group. FNB group will receive 20 mL of 1.5% lignocaine 5 min before positioning for spinal block. FENT group will receive injection fentanyl 1 μg/kg IV 5 min prior to positioning. The random allocation sequence is concealed in opaque, sealed envelopes until a group was assigned. On arrival in the induction area, all patients will be monitored with electrocardiography, pulse oximeter, and non-invasive blood pressure measurement. An IV line will be secured and infusion of lactated Ringer’s solution started as maintainance and all patients supplied with oxygen (6 L/min) via a face mask. Patients in the FNB group will receive FNB under ultrasonic guidance 5 min before positioning for spinal block. FNB will be performed by one of two anaesthesiologists. Entry point will be infiltrated with 1 ml 1% lignocaine. After visualisation of femoral nerve in USG 20 mL of 1.5% lignocaine will be injected incrementally after a negative aspiration test. Patients in the FENT group will receive injection fentanyl 1 μg/kg IV 5 min prior to positioning. If any patient in either group reports pain scores ≥4 during positioning, IV fentanyl 0.5 μg/kg will be given every 5 min until the pain score decreased to <4 or maximum dose of 3 μg/kg will be given (whichever first); if pain score <4 could not be achieved, patients will be excluded from study. Spinal block will be performed by anaesthesiologist who is blinded for the study. The spinal block will be performed either by the midline or paramedian approach at the L2/3 or L3/4 level, according to the anaesthesiologist’s decision. ASSESSMENT Following methodology will be used for assessment of parameters. 1. Pain score using visual analogue scale (0 = no pain , 10 = maximal pain) 2. Additional fentanyl requirements during positioning. 3. Patient positioning and satisfaction of anaesthesiologist for spinal block by satisfaction scale (0 = not satisfactory, 1 = satisfactory, 2 = good, 3 = optimal). 4. Patient discomfort (YES or NO). 5. Vital parameters:- heart rate (HR), mean arterial pressure (MAP) by non-invasive blood pressure and oxygen saturation (SpO 2 ) will be monitored. 6. Side effects |