ORIGINAL RESEARCH ARTICLE

POSITIONING OF FRACTURE FEMUR PATIENTS FOR SPINAL ANAESTHESIA: FEMORAL NERVE BLOCK OR INTRAVENOUS FENTANYL?

Amarjeet Kumar, Chandni Sinha , Ajeet Kumar, Poonam Kumari, Umesh Kumar Bhadani, Ditipriya Bhar

Amarjeet Kumar
Assistant professor (Anaesthesiology) Department of trauma & Emergency AIIMS Patna

Chandni Sinha
Associate Professor, Department of Anaesthesia, AIIMS, Patna. Email: chandni.doc@gmail.com

Ajeet Kumar
Associate Professor, Department of Anaesthesia, AIIMS, Patna

Poonam Kumari
Assistant Professor, Department of Anaesthesia, AIIMS, Patna

Umesh Kumar Bhadani
Professor & Head, Department of Anaesthesia, AIIMS, Patna

Ditipriya Bhar
Senior Resident, Department of Community & family medicine
Online First: December 30, 2018 | Cite this Article
Kumar, A., Sinha, C., Kumar, A., Kumari, P., Bhadani, U., Bhar, D. 2018. POSITIONING OF FRACTURE FEMUR PATIENTS FOR SPINAL ANAESTHESIA: FEMORAL NERVE BLOCK OR INTRAVENOUS FENTANYL?. Bali Journal of Anesthesiology 2(3): 61-64. DOI:10.15562/bjoa.v2i3.81


Background: Fracture of the femur is a common, but extremely painful bone injury. Anaesthesiologists face the common problem of improper positioning of the patient while giving sitting spinal due to their extreme pain.

Methods: After Institutional Ethical Committee (IEC) clearance, 60 of American Society of Anaesthesiologists (ASA) I/II patients age 18 to 80 years with fracture femur were recruited. Patients in Femoral Nerve Block (FNB) group received ultrasound-guided FNB was given with 15 mL of 1% lignocaine after visualizing the femoral nerve. Patients in the fentanyl group received injection fentanyl 1μg/kg IV. The target was to reduce the Visual Analog Scale (VAS) score less than 4. If despite the intervention, VAS was more than 4, a repeat fentanyl dose (0.5μg/kg) was given.

Results: Mean VAS during positioning was 1.57 in FNB versus 2.93 in the fentanyl group (p<0.001). An additional dose of fentanyl required was less in FNB group and was more in fentanyl group (p<0.001). Performer rated quality of patient position was more in FNB group (mean±SD) 2.73 + 0.450 while1.47 + .507 in fentanyl group. This difference was statistically more significant (p<0.001). Patients satisfaction was more in the FNB group than fentanyl group (p<0.001) which was highly significant.

Conclusion: Ultrasound-guided FNB provides better analgesia, patient satisfaction, less time for anesthesia and satisfactory positioning than IV fentanyl for a central neuraxial block in patients undergoing surgeries for femur fractures.

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