The analgesic efficacy of landmark-guided fascia iliaca compartment blockwith dexamethasone-bupivacaine in femoral fracture surgery undersubarachnoid anaesthesia in resource-limited settings
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Abstract
Background: Femoral fractures often lead to severe pain especially during patient resuscitation, transfers, and positioning for anaesthesia. Fascia Iliaca Compartment Block (FICB) with bupivacaine offers excellent pain relief for this group of patients, but the analgesic effect might not last long enough for postoperative pain management.
Aim and Objectives: We evaluated the impact of adding dexamethasone to bupivacaine in FICB on the duration of analgesia, postoperative pain scores, opioid requirements and patient satisfaction among femoral fracture patients in North West Nigeria.
Patients and Methods: In this single-blind study, we randomly assigned 80 patients with femoral fractures, aged 18 to 80 years, scheduled for open reduction and internal fixation, into two groups. Group BD (40 patients) received a landmark-guided Fascia Iliaca Compartment Block (FICB) with 38 ml of 0.25% bupivacaine and 6 mg of dexamethasone (2 ml). Group B (40 patients) received a similar FICB with 38 ml of 0.25% bupivacaine and 2 ml of normal saline. Spinal anesthesia was administered 30 minutes after the FICB for surgical anesthesia. We compared the duration of analgesia, 24-hour tramadol requirements, and patient satisfaction between the two groups
Results: Group BD reported significantly lower pain scores at 4, 12 and 24 hours, and reduced 24 hours tramadol consumption compared to Group B. The Mean VAS score at 24 hours was 4.25±0.494 and 4.53±0.679 in groups BD and B respectively, p =0.042. Mean 24-hour tramadol consumption was 160±63.20mg for Group BD and 453±75mg for Group B, p=0.001. The duration of analgesia was also longer in Group BD: 20±2.40 hours vs. 8.38±1.82 hours, in group B; p=0.001. Eighty percent (80%) of patients in Group BD reported being "very satisfied” with the anaesthesia, while only 25% of patients in Group B expressed the same level of satisfaction. Notably, all of the patients in the study reported some level of satisfaction with the level of pain control achieved through FICB.
Conclusion: This study demonstrates that the addition of dexamethasone to bupivacaine for FICB effectively extends the duration of analgesia, reduces postoperative pain scores, and decreases opioid consumption. In addition, it gives better patient satisfaction compared to the use of bupivacaine only.
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