Perioperative pain in older adults with femur fracture received under spinal anaesthetic (SA) is a complex issue due to the interplay of risks of postoperative delirium, postoperative opioid effect and the prevalence of pain. Whether fascia iliaca compartment block (FICB) is more effective than IV fentanyl in enhancing positioning conditions, peri-operative pain control, opioid use and postoperative delirium. ASA physical status I to ASA physical status III patients of age = 65 years was studied in this RTC study. The participants were randomly assigned to two groups: FICB (n=60) or intravenous fentanyl group (n=60). The baseline data were not different between groups (p > 0.05). The FICB group had significantly better positioning conditions, lower VAS (3.2 ± 0.9 vs 5.8 ± 1.1, p < 0.001), better ease of positioning and a shorter time to spinal anaesthesia (6.5 ± 1.8 vs 10.2 ± 2.4 min, p < 0.001). No significant differences in pain rating scores were found except in the FICB group where scores were significantly lower at all times (p<0.001). Total opioid consumption was significantly reduced in the FICB group (18.6 ± 6.4 vs 42.3 ± 10.7 MME, p < 0.001). The FICB group also had a fewer number of delirium cases (10% versus 25% p = 0.03). The effect size analysis showed a large analgesic effect (Cohen's d = 1.12) and the regression analysis found an independent protective effect of FICB against delirium (OR = 0.38, p < 0.01). In elderly patients, undergoing spinal anaesthetic surgery for femur fracture, fascia iliaca compartment block has been shown to be more effective at providing perineurial analgesia than intravenous fentanyl.
Perioperative Analgesia, Intravenous Fentanyl, Fascia Iliaca Compartment Block, FICB and Femur Fracture Surgery.
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