Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block.
BACKGROUND
In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture.


METHODS
The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 microg/kg, followed by a continuous infusion of alfentanil 0.25 microg/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual analogue pain scale (VAS) scores, time to achieve spinal anaesthesia, quality of patient positioning, and patient acceptance were compared.


RESULTS
VAS scores during positioning (mean and range) were lower in the FIC group than in the IVA group [2.0 (1-4) vs. 3.5 (2-6), P=0.001], and the mean (+/- SD) time to achieve spinal anaesthesia was shorter in the FIC group (6.9 +/- 2.7 min vs. 10.8 +/- 5.6 min; P=0.009). Patient acceptance (yes/no) was also better in the FIC group (19/1) than in the IVA group (12/8)(P=0.008).


CONCLUSIONS
An FIC block is more efficacious than i.v. alfentanil in terms of facilitating the lateral position for spinal anaesthesia in elderly patients undergoing surgery for femoral neck fractures.
Yun
M J
MJ
Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
Kim
Y H
YH
Han
M K
MK
Kim
J H
JH
Hwang
J W
JW
Do
S H
SH
D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil / Q000008:administration & dosage; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D005205:Fascia; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D015760:Alfentanil; D002045:Bupivacaine