Bhatia Nidhi, Jain Kajal, Saini Vikas, Saini Uttam C, Khurana Bismanjeet, Makkar Jeetinder K
Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
Department of Orthopedics, PGIMER, Chandigarh, India.
Indian J Anaesth. 2025 Apr;69(4):335-342. doi: 10.4103/ija.ija_1095_24. Epub 2025 Mar 13.
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 ( = 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.
文献中提及了多种用于股骨近端骨折后疼痛管理的周围神经阻滞方法。我们旨在探索这些患者的最佳镇痛方案，同时比较股神经阻滞和髂筋膜间隙阻滞。
60例因股骨近端骨折入院接受全身麻醉下手术固定的成年创伤患者，随机分为接受超声引导下采用腹股沟上（SFICB组）或腹股沟下（IFICB组）方法的连续髂筋膜平面阻滞或股神经阻滞（FNB组）进行术后镇痛，初始推注0.2%罗哌卡因（剂量根据患者体重），随后在前24小时以10 mL/h的速度持续输注。静脉注射吗啡用作补救镇痛药（RA），以维持视觉模拟评分（VAS）<4分。我们的主要目标包括术后24小时内使用的RA总剂量。作为次要结果，记录了RA总消耗量、镇痛持续时间、疼痛评分、疼痛缓解质量和不良反应。
SFICB组使用的RA剂量显著更低，SFICB组中15%的患者需要RA推注，而IFICB组和FNB组分别为40%和50%。SFICB组患者的吗啡中位消耗量较低，SFICB组为3 mg[四分位间距（IQR）：0 - 3；范围：0 - 3.5]，而IFICB组和FNB组分别为6.5 mg（IQR：4.1 - 8.0；范围：3 - 10.5）和9.0 mg（IQR：5.3 - 14.0；范围：3 - 14）（P = 0.044），VAS评分显著降低，且疼痛缓解质量更佳。
股骨近端骨折手术后，与腹股沟下方法或单纯股神经阻滞相比，连续腹股沟上髂筋膜间隙阻滞提供了更好的疼痛缓解效果。
