Analgesic efficacy of perioperative ultrasound-guided fascia iliaca block in geriatric patients receiving spinal anesthesia for hip fracture surgery
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Abstract
Introduction: Effective perioperative pain management in elderly patients undergoing hip fracture surgery remains challenging. Inadequate pain control not only increases the patient’s distress but may also lead to postoperative complications. The fascia iliaca compartment block (FICB) has been shown to enhance analgesia and improve patient comfort. This study aims to compare the analgesic efficacy of FICB when performed prior to spinal anesthesia in patients undergoing hip fracture surgery. Methods: A prospective randomized study was conducted in 54 elderly patients undergoing hip fracture surgery under spinal anesthesia. Patients were randomly assigned to receive either an ultrasound-guided FICB with 0.25% bupivacaine 40 mL (block group) or sham ultrasound without injection (control group). The prespecified primary outcome was total postoperative morphine consumption at 24 and 48 h. Secondary outcomes included pain during positioning for spinal anesthesia, postoperative pain, patient satisfaction, and adverse events. Longitudinal pain outcomes were analyzed using a linear mixed-effects model. Results: Total morphine consumption at 24 and 48 h was not significantly different between the groups. However, patients in the block group had significantly lower postoperative pain during ambulation. Mixed-effects modelling confirmed a significant overall group effect for postoperative pain on movement (P = 0.009). Pain during positioning for spinal anesthesia was significantly lower in the block group (P < 0.001). Correspondingly, the time required to perform spinal anesthesia was significantly shorter in the block group (P < 0.001). The incidence of complications was similar between groups. Conclusions: Although postoperative opioid consumption did not differ between groups, FICB improved pain during positioning for spinal anesthesia and decreased pain during ambulation without increasing complications.
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