Comparison of combined femoral nerve block and spinal anesthesia with lumbar plexus block for postoperative analgesia in intertrochanteric fracture surgery.
BACKGROUND
Hip fracture-related pain both before and after surgery is generally reported as severe by most patients. Various regional pain control modalities have been described in order to reduce pain in these patients.


OBJECTIVE
Because of the challenges of lumbar plexus block (LPB) and the fact that the effect of combined femoral nerve block/spinal anesthesia in controlling pain after orthopedic surgeries has not been investigated, in this study, we compared the feasibility and efficacy of the 2 techniques in the perioperative management of proximal hip fractures.


METHODS
The study included 32 patients with femoral intertrochanteric fracture who were randomly divided into the following 2 groups of 16 patients each: combined femoral nerve block/spinal anesthesia group (group I) and LPB group (group II). Patients in group I received 0.17% bupivacaine with 0.7% lidocaine, 20-25 mL for femoral nerve block and bupivacaine 0.5% plus 0.5 mL pethidine (25 mg) for spinal block and patients in group II received 0.17% bupivacaine with 0.7% lidocaine, 30-35 mL.


RESULTS
The time for performing the block (12.2 ± 3.3 vs. 4.93 ± 1.6 min, P = 0.001) and achieving the block (7.7 ± 0.9 vs. 2.4 ± 1.0 min, P = 0.001) were significantly longer in the combined femoral nerve block/spinal anesthesia group than in the LPB group. Duration of analgesia in the combined femoral nerve block/spinal anesthesia group was longer than that in the LPB group, but the difference was not significant (17 ± 7.3 vs. 16.5 ± 8.5 h, P = 0.873). There were no significant differences in hemodynamic parameters regarding the method of anesthesia in the 2 groups.


CONCLUSIONS
This study confirms that the combination of femoral nerve block with spinal anesthesia is safe and comparable with LPB and can provide more effective anesthesia and longer lasting analgesia for intertrochanteric surgery.
Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Hamid Reza
HR
Amiri
Saeid
S
Safari
Jalil
J
Makarem
Mojgan
M
Rahimi
Behnaz
B
Jahanshahi
Analgesia; Anesthesia, Spinal; Femoral Nerve; Hip Fractures; Lumbosacral Plexus