Proximal Femur Fractures
Conditions
Brief summary
Fracture femur is a common injury which is associated with excruciating pain. Positioning for neuraxial blocks is always challenging because even slight overriding of the fracture ends is intensely painful .It can causing major patient distress which accompanied by well-known physiological sequelae such as sympathetic activation causing tachycardia, hypotension, and increased cardiac work that may compromise high-risk cardiac patients. Fascia iliaca compartment block is highly effective in blocking lateral cutaneous nerve of the thigh and femoral nerve. Fascia iliaca compartment block is not only easy to perform but it is also associated with minimal risk as the local anesthetic is injected at a safe distance from the femoral artery and femoral nerve. It is always safe to perform the fascia iliaca compartment block prior to spinal anesthesia as the patient can respond during administration of the local anesthetic and can prevent intra-neuronal injections
Detailed description
On arrival to the pre-operative holding area half hour before the scheduled surgery. Patient will be connected to basal monitoring devices; pulse oximetry and non- invasive blood pressure. Fascia iliaca compartment block will be performed with the aid of ultrasound device in all cases.The injected local anesthetic solution will be prepared by a staff member who was not involved in the study) according to the randomization. After 20 minutes from the injection the investigators will assessed nerves that had been blocked. On arrival to the operative theater, under complete aseptic technique spinal anesthesia will be carried out in the sitting position (if there is severe pain at positioning we will use lateral position) at space between L3-4 or L4-5 using a 25-gauge spinal quincke needle. After feeling the desired space, the needle will be advanced (paramedian approach) till free flow of cerebrospinal fluid dropped from the needle then 15 mg hyperbaric bupivacaine+20mic fentanyl will be injected.
Interventions
DRUGPlacebo
Patients received ultrasound guided fascial iliaca compartment blockade using normal saline 0.9%, 40 ml
DRUGBupivacaine
Patients received ultrasound guided fascial iliaca compartment blockade using bupivacaine 0.25%, 40 ml
DEVICEUltrasound guided fascia iliaca compartment block
Ultrasound guided fascia iliaca compartment block
DRUGIntrathecal medications (bupivacaine (15 mg) in conjunction with fentanyl 20 micrograms)
Intrathecal hyperbaric bupivacaine (15 mg) in conjunction with fentanyl 20 micrograms
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologist physical status I to III * Patients scheduled for fixation for proximal end femur fracture
Exclusion criteria
* Patients refusal * Morbid obese patients (BMI\>40) * Bleeding diathesis * Previous femoral bypass surgery * Inguinal hernia * Inflammation/infection over injection site * Peripheral neuropathy * Allergy to local anesthetics agents used. * Severely altered consciousness level * Psychiatric disorders * Polytrauma
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain scores | For 24 hours after performance the blockade | Pain was assessed using visual analogue score |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood pressure | For 24 hours after performance the blockade | — |
| Peripheral oxygen saturation | For 24 hours after performance the blockade | — |
| Time to performing spinal anesthesia | For 30 min after placement of patient in the optimum position | Time from the placement of patient in the optimum position to the intra-thecal injection of bupivacaine |
| Number of trials of dural puncture | For 30 min after placement of patient in the optimum position | — |
| Heart rate | For 24 hours after performance the blockade | — |
| Duration of sensory blockade | For 12 hours after performing spinal anesthesia | — |
| Duration of analgesia | For 24 hours after performing spinal anesthesia | Time from performing spinal anesthesia to first analgesic request |
| Cumulative consumption of analgesics | For 24 hours after performing spinal anesthesia | Total opioid or other analgesics received for the first 24 hours after surgery. |
| Duration of motor blockade | For 12 hours after performing spinal anesthesia | — |
Countries
Egypt
Outcome results
None listed