Ultrasound guided continuous femoral nerve sheath block versus continuous epidural analgesia after internal fixation of fractured neck femur

ABSTRACT

Continuous peripheral nerve blocks provide extended, site specific post-operative analgesia with few side effects. Ultrasound guidance can significantly improve the quality of nerve blocks in almost all types of regional anesthesia. The aim of the present study is to compare continuous femoral sheath block, under ultrasound guidance, with continuous epidural analgesia in terms of analgesic efficacy at rest and during movement, complications, and patients satisfaction. Thirty five ASA physical statuses I to III patients scheduled for internal fixation of fracture neck femur under general anesthesia were included in this study. Patients were divided into two groups in a randomized fashion. During the first 48 h postoperatively, analgesia was provided by using continuous femoral nerve sheath block group A [GA] or continuous epidural analgesia group B [GB]. The intensity of pain at rest and on movement was assessed by the patients using a visual analog scale [0 = no pain, 100 = worst possible pain] at 2, 4, 8 h and every 8 h for 48 h after the operation. If the VAS was >/= 3 the patient could receive additional morphine 2 mg every five to ten minutes; up to 4-6 mg according to age and general condition of patient. Times of catheter insertion and difficulty were significantly high in GA, no vascular puncture happened during procedures in both groups. VAS at rest and on movement present no significant difference between the groups allover the time of study. Cumulative morphine dose over 48 h was not significantly different, but satisfaction was significantly high in GA. Pain at insertion site was high in GA compared to GB where it was 5 and 3 respectively. Local signs of infection present in 2 patients in GA, but no patient had local signs of infection in GB. Inadvertent catheter removal as well as kinked catheter was occurred in one patient in each group. Hypotension, urine retention and need of antiemetic were high in GB. We can concluded that, ultrasound guided continuous femoral nerve sheath block offers a technically easy and safe method, with faster onset and better quality, for providing post-operative analgesia in patients undergoing internal fixation of fractured neck femur. However, it must be done under strict and complete aseptic conditions to avoid local infection which can spread to form psoas abscess