Comparison of ropivacaine, bupivacaine, and lignocaine in femoral nerve block to position fracture femur patients for central neuraxial blockade in Indian population
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Background: Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine and 1.5% lignocaine for FNB in fracture femur patients.Methods: Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction. Results: Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P<0.001). In group B, 12 patients required additional fentanyl to achieve a VAS <4. Patient positioning was reported to be satisfactory in all patients in group R and L, while in B it was satisfactory in 13 (52%) patients only. Patient acceptance of FNB was 100% in group R and L, but only 64% in group B.Conclusions: Based on our findings, 0.5% ropivacaine is a favorable choice for FNB due to early onset, ability to yield a good quality block, and good safety profile.
Abstract
Background: Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine and 1.5% lignocaine for FNB in fracture femur patients.Methods: Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction. Results: Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P<0.001). In group B, 12 patients required additional fentanyl to achieve a VAS <4. Patient positioning was reported to be satisfactory in all patients in group R and L, while in B it was satisfactory in 13 (52%) patients only. Patient acceptance of FNB was 100% in group R and L, but only 64% in group B.Conclusions: Based on our findings, 0.5% ropivacaine is a favorable choice for FNB due to early onset, ability to yield a good quality block, and good safety profile.
참고문헌 (13)
- Cooper C, "Hip fractures in the elderly : a world-wide projection", Osteoporos Int, 2, pp.285~289 (1992)
- Dhanwal DK, "Incidence of hip fracture in Rohtak district, North India", Arch Osteoporos, 8, pp.135~ (2013)
- Sandby-Thomas M, "A national survey into the peri-operative anaesthetic management of patients presenting for surgical correction of a fractured neck of femur", Anaesthesia, 63, pp.250~258 (2008)
- McGlone R, "Femoral nerve block in the initial management of femoral shaft fractures", Arch Emerg Med, 4, pp.163~168 (1987)
- Barriot P, "Femoral nerve block in prehospital management of fractured shaft of femur", JEUR, 1, pp.21~24 (1988)
- Berry FR, "Analgesia in patients with fractured shaft of femur", Anaesthesia, 32, pp.576~577 (1977)
- Sia S, "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", Anesth Analg, 99, pp.1221~1224 (2004)
- Jadon A, "Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture", Indian J Anaesth, 58, pp.705~708 (2014)
- Morrison SG, "A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine", Anesth Analg, 90, pp.1308~1314 (2000)
- Swami SS, "Comparison of dexmedetomidine and clonidine(α2 agonist drugs)as an adjuvant to local anaesthesia in supraclavicular brachial plexus block : a randomised double-blind prospective study", Indian J Anaesth, 56, pp.243~249 (2012)
- Fanelli G, "A double-blind comparison of ropivacaine, bupivacaine, and mepivacaine during sciatic and femoral nerve blockade", Anesth Analg, 87, pp.597~600 (1998)
- Casati A, "Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks", Anesthesiology, 90, pp.1047~1052 (1999)
- Kuthiala G, "Ropivacaine : a review of its pharmacology and clinical use", Indian J Anaesth, 55, pp.104~110 (2011)