A Study to compare Three- in- one nerve block and fascia iliaca compartment block to facilitate positioning of patients with hip fracture for spinal Anaesthesia
Fracture of femur is extremely painful because it involves the periosteum which has a very low pain threshold. Spinal anesthesia is commonly used to facilitate surgical repair in these patients. Positioning in these patients for spinal anesthesia resulting into even minimal movements of fracture ends is very painful. Femoral nerve block or three-in-one nerve block have been used for providing analgesia in such patients. This study was designed to compare three-in-one nerve block (TINB) and fascia iliaca compartment block(FICB) to facilitate positioning of patients with hip fracture for spinal anesthesia.
After approval from institutional ethics committee , 60 adults undergoing surgery for hip fracture were randomly allocated to receive either TINB (n=30) or FICB (n=30) using 0.5% ropivacaine under ultrasound guidance. Sensory blockade, VAS score and hemodynamics were assessed at 10 minutes and 20 minutes after block. Quality of patient positioning and VAS score were noted when the patients were made to sit for spinal anesthesia.
Sensory blockade at 10 minutes in lateral, anterior and medial part of thigh was obtained in 18(54%) and 4(12%) [p< 0.001]; 17(68%) and 16(48%) [p= 0.79]; 11(33%) and 7(21%) [p= 0.26] of the patients in FICB and TINB groups respectively. At 20 minutes sensory blockade progressed to 23(69%) and 15(45%), [p= 0.032] patients in lateral part of thigh in FICB and TINB groups respectively, 26(68%) in anterior and 19(57%) patients in medial part of thigh in each group. Complete sensory blockade was observed in 22(66%) patients in FICB group compared to 14(42%) in TINB group, [p= 0.02]. Partial blockade was observed in 8(24%) patients in FICB group compared to 16(48%) patients in TINB group, [p= 0.432]. Twenty minutes after block VAS score decreased from baseline of 7.70±1.37(mean±SD) to 4.33±1.40(mean±SD) in FICB group and from baseline of 7.73±1.48(mean±SD) to 4.40 ±0.81(mean±SD) in TINB group.There was no block failure .
Our study results indicate that FICB is better analgesic technique compared to TINB to facilitate sitting position for spinal anesthesia in patients undergoing surgery for hip fracture, as lateral femoral cutaneous nerve is blocked more effectively. Our findings are supported by a study done by Capdevilla et al who compared TINB and FICB with regards to analgesic efficacy and correlation between radiographic spread of local and clinical anesthetic distribution of anesthesia. They observed that FICB provides faster and more consistent simultaneous blockade of lateral femoral cutaneous nerve . In literature, there are variable reports regarding comparison of postoperative analgesic efficacy of FICB and TINB. Although primary aim of our study was not finding postoperative analgesic efficacy of both the blocks; there was equivalent consumption of analgesics postoperatively in patients who were provided either FICB or TINB. The limitation of our study was that we did not use catheter technique which would have provided postoperative pain relief as well.
1. Yun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH. Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block. ActaAnaesthesiolScand2009;53:1282-7.
2. Capdevila X, Biboulet PH, Bouregba M, Barthelet Y, Rubenovitch J, d’Athis F. Comparison of the Three-in-One and Fascia Iliaca Compartment Blocks in Adults: Clinical and Radiographic Analysis. AnesthAnalg1998;86:1039-44.