title: Preoperative fascia iliaca compartment block for positioning patients with hip fractures for central nervous blockade: a randomized trial.
abstract: OBJECTIVE
  Appropriate pain management may positively affect outcome following hip fractures. Positioning patients for spinal anesthesia (SA) can be extremely painful. Peripheral nerve blockades are gaining popularity in this setting. This prospective, randomized study compares the efficacy of fascia iliaca compartment block (FICB) to intravenous (IV) fentanyl for positioning hip fracture patients for SA.
  
  
  METHODS
  Forty-one patients scheduled for hip fracture surgery were randomized to receive a bolus dose of IV fentanyl (IVFE) 1.5 μg/kg (IVFE group) or an FICB using 40 mL ropivacaine 0.5% (FICB group) 5 or 20 minutes before positioning for SA, respectively. Numeric rating pain scale scores before and following the analgesic intervention, time needed and quality of patient position for SA performance, postoperative analgesia in terms of time to first IV morphine dose demand and morphine consumption during the first 24 hours, and patient satisfaction were documented.
  
  
  RESULTS
  Compared with the IVFE group, the FICB group showed significantly lower numeric rating pain scale scores in all instances following the analgesic intervention (P < 0.001), shorter spinal performance time (P = 0.001), and better quality of position (P = 0.001). Postoperative morphine consumption was lower (P = 0.026), the time to first dose demand was longer (P = 0.001), and patient satisfaction rates were higher (P < 0.001) in the FICB group.
  
  
  CONCLUSIONS
  Performing an FICB before positioning for SA provides superior pain management compared with IVFE administration, facilitates spinal performance, and yields satisfactory postoperative analgesia and wide patient acceptance, hence improving overall quality and efficiency of care.
authors: From the *Department of Anesthesiology, Asklepieion Hospital of Voula; and †Department of Microbiology, University of Athens School of Medicine, Aretaieio Hospital, Athens, Greece.
authors: Maria
authors: M
authors: Diakomi
authors: Marianna
authors: M
authors: Papaioannou
authors: Argyro
authors: A
authors: Mela
authors: Evangelia
authors: E
authors: Kouskouni
authors: Alexandros
authors: A
authors: Makris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005205:Fascia; D005260:Female; D005283:Fentanyl; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management; D010147:Pain Measurement / Q000187:drug effects; D056888:Patient Positioning / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl