DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175718

The effect of 0.25% levobupivacaine and 0.25% ropivacaine in fascia iliaca block in elderly patients with fracture femur given before positioning for subarachnoid block

Neetu Gupta, Pooja Jain, M. Kapadia, Sadhana Sanwatsarkar, Dipti Saxena, Meghna Maheshwari

Abstract


Background: Positioning of elderly patients with fracture femur for subarachnoid block (SAB) is a challenging task, both for the patient and anesthesiologist. Severe pain not only adds to the morbidity but also alters the success rate of SAB as appropriate positioning becomes difficult. Fascia iliaca compartment block (FICB) is a simple, rapid, effective and safe method for achieving excellent pain relief. The purpose of this study is to compare the efficacy of 0 .25% of levobupivacaine and 0.25% ropivacaine in FICB on reducing preoperative and postoperative pain and analgesic consumption in lower limb surgery.

Methods: 60 elderly patients of ASA class I-III scheduled for elective fracture femur surgery were enrolled in the study and randomly divided into two groups. Group L received 30ml 0.25% levobupivacaine in FICB while Group R received 0.25% ropivacaine in FICB 15min before SAB. Parameters recorded were blood pressure, heart rate, visual analogous scale (VAS), quality of positioning and time to first rescue analgesia. VAS was noted before and after performing FICB and at the time of positioning for subarachnoid block (SAB).

Results: The VAS score at different time interval and time to first rescue analgesia were comparable (P >0.05). Quality of positioning was also similar in both the groups (P >0.05).

Conclusions: The study demonstrates that levobupivacaine and ropivacaine produce comparable preoperative and postoperative analgesia when used for FICB.


Keywords


FICB, Ropivacaine, Levobupivacaine, SAB, VAS

Full Text:

PDF

References


Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology: Journal Ame Soci Anesthesiol. 2012;117(1):72-92.

Garstin WI, Brown JG, Taylor TC, Howe JP. Spinal anaesthesia for surgical correction of fracture of the proximal femur. Ulster Medic J. 1987;56(1):39.

Iamaroon A, Raksakietisak M, Halilamien P, Hongsawad J, Boonsararuxsapong K. Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur. Local Regional Anes. 2010;3:21.

Sia S, Pelusio F, Barbagli R, Rivituso C. Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl. Anes Analgesia. 2004;99(4):1221-4.

Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Annals Emergency Medic. 2003;41(2):227-33.

Foss NB, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, Hougaard S, Kehlet H. Fascia Iliaca Compartment Blockade for Acute Pain Control in Hip Fracture PatientsA Randomized, Placebo-controlled Trial. J Ame Soci Anesthesiol. 2007;106(4):773-8.

Lako SJ, Steegers MA, van Egmond J, Gardeniers J, Staals LM, van Geffen GJ. Incisional continuous fascia iliaca block provides more effective pain relief and fewer side effects than opioids after pelvic osteotomy in children. Anesthesia Analgesia. 2009;109(6):1799-803.

Yun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH. Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block. Acta Anaesthesiologica Scandinavica. 2009;53(10):1282-7.

Yezierski RP. The effects of age on pain sensitivity: preclinical studies. Pain Medic. 2012;13(suppl_2):S27-36.

Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10(3):179-87.

Pompei P, Foreman M, Rudberg MA, Inouye SK, Braund V, Cassel CK. Delirium in hospitalized older persons: outcomes and predictors. J Ame Geriatrics Soci. 1994;42(8):809-15.

Sia S, Pelusio F, Barbagli R, Rivituso C. Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl. Anesthesia Analgesia. 2004;99(4):1221-4.

Dalens B, Vanneuville G, Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesthesia Analgesia. 1989;69(6):705-13.

Capdevila X, Biboulet PH, Bouregba M, Barthelet Y, Rubenovitch J, d'Athis F. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesthesia & analgesia. 1998;86(5):1039-44.

Denise J. Wedel, Terese T. Horlocker. Nerve Blocks. Miller’s Anaesthesia. 7th edition: Churchil Livingstone Elsevier; New York. 2010;52: 1639-75.

Hanna M, Sloan P. A comparison of levobupivacaine and ropivacaine for interscalene and femoral nerve blocks: a randomized, double-blind, prospective clinical trial. J Anesthesia Clinic Res. 2011;2(5):135.

De Leeuw MA, Dertinger JA, Hulshoff L, Hoeksema M, Perez RS, Zuurmond WW, et al. The efficacy of levobupivacaine, ropivacaine, and bupivacaine for combined psoas compartment-sciatic nerve block in patients undergoing total hip arthroplasty. Pain Practice. 2008;8(4):241-7.

Pujol E, Faulí A, Anglada MT, López A, Pons M, Fàbregas N. Ultrasound-guided single dose injection of 0.5% levobupivacaine or 0.5% ropivacaine for a popliteal fossa nerve block in unilateral hallux valgus surgery. Revista espanola de anestesiologia y reanimacion. 2010;57(5):288-92.

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg. 2000;90:642-8.

Capogna G, Celleno D, Fusco P, Lyons G, Columb M. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Brit J Anaesthesia . 1999;82(3):371-3.