Continuous peripheral nerve block in patients with proximal femur fracture: A randomised comparison of three...

The literature mentions numerous approaches to peripheral nerve blockade for pain management following proximal femur fractures. We aimed to explore the best analgesic option in these patients while comparing blocks of the femoral nerve and fascia iliaca compartment.

Sixty consenting adult trauma patients admitted with proximal femur fractures for surgical fixation under general anaesthesia were randomised to receive either sonography-guided continuous fascia iliaca plane block employing suprainguinal (SFICB group) or infrainguinal (IFICB group) approach or femoral nerve block (FNB group) for postoperative analgesia, using 0.2% ropivacaine as initial bolus (volume based on patient's weight), followed by its continuous infusion @10 mL/h for first 24 h. Intravenous morphine was used as a rescue analgesic (RA) to keep a visual analogue scale (VAS) score of <4. Our primary objective included a total number of RA doses administered in the 24-h postoperative period. As secondary outcomes, total RA consumption, analgesia duration, pain scores, quality of pain relief, and adverse effects were noted.

The number of RA doses administered was significantly lower in the SIFCB group, with 15% of patients requesting RA boluses in the SFICB group as opposed to 40% and 50% of patients in the IFICB and FNB groups, respectively. Patients in the SFICB group had lower median morphine consumption of 3 mg [interquartile range (IQR): 0-3; range: 0-3.5] in the SFICB group versus 6.5 mg (IQR: 4.1-8.0; range: 3-10.5) and 9.0 mg (IQR: 5.3-14.0; range: 3-14) in the IFICB and FNB groups, respectively (P = 0.044), significantly decreased VAS scores, and reported superior quality of pain relief.

Following proximal femur fracture surgery, superior pain relief was provided by continuous suprainguinal fascia iliaca compartment block compared to the infrainguinal approach or simple femoral nerve block.