Comparison of Preemptive and Post Operative Fascia Iliaca Compartment Block for Alleviating Pain and Post Operative Delirium in Elderly Patients with Proximal Femur Fracture Surgery

Abstract

Background and Aim: Pain management is a challenging issue in elderly patients with hip fracture. Adequate pain relief before administrating spinal blockade will increase patient’s cooperation. This study was done to assess analgesic effect of fascia iliaca compartment block (FICB) for positioning for spinal anesthesia. Present Study was done with an aim to evaluate and compare the analgesic effect of Pre-emptive Fascia Iliaca Compartment block (FICB) and Post-operative Fascia Iliaca Compartment Block on the incidence of post-operative delirium in geriatric patients undergoing proximal femur fracture surgeries under spinal anaesthesia.
Material and Methods: A Prospective, Randomised, single blind, comparative study recruiting 110 patients posted for proximal femur fracture surgery. The two groups were assigned randomly. Landmark guided FICB will be given 30 mins Prior to surgery with 23G 1 ½ Inch block needle with Inj. Ropivacaine (0.25%) 30ml. Spinal Anaesthesia would be performed with Inj.Bupivacine (0.5%) heavy. GROUP B (POST FICB Group): When effect of central neuroaxial block (S/A) reach up to level L1 and after shifting Patient in recovery room Landmark guided FICB is given with Inj. Ropivacaine (0.25%) 30 ml. Vitals were monitored before and after block, at the time of positioning for spinal anesthesia, intraoperative and postoperative periods.
Results: At Completion of surgery, after regression of SAB to L1, after 30 minutes, 1 Hour, 6 Hour and 24 Hour of postoperative period there was a significant difference between VAS of Group A and Group B. The mean total duration of analgesia in Group A was 6.13 hr min after spinal anesthesia, whereas in Group B, mean total duration of analgesia was 5.38 hr. There was statistically significant difference in the total duration of analgesia in postoperative period between Group A and Group B.
Conclusion: FICB effectively provides analgesia for positioning for spinal anesthesia to patients in hip and proximal femur surgeries. It also provides analgesia in postoperative period without having significant alteration in the hemodynamic profile of patients.