Comparison of Ultrasound-Guided Fascia Iliaca Compartment Block Versus Intravenous Tramadol for Positioning of Femur Fracture Patients Before Spinal Anaesthesia

Mayo Hospital Lahore64 enrolled

Overview

This randomized clinical study compared two methods of pain relief used before spinal anaesthesia in patients undergoing surgery for a femur fracture. Positioning a patient with a fractured femur into the side-lying position required for spinal anaesthesia can cause severe pain because movement may disturb the fractured bone. A total of 64 patients aged 18 to 60 years were included and were assigned to one of two treatment groups. One group received intravenous tramadol, while the other group received an ultrasound-guided fascia iliaca compartment block, in which local anaesthetic was injected near the nerves supplying the hip and upper thigh. Pain was measured using a visual analogue scale when the patient arrived on the operating table and again during positioning in the lateral decubitus position before spinal anaesthesia. The study was conducted to determine which treatment provided better pain relief and made positioning for spinal anaesthesia more comfortable. It was hypothesized that the ultrasound-guided fascia iliaca compartment block would reduce pain during positioning more effectively than intravenous tramadol.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Conditions

Femoral Fractures Acute Pain

Interventions

Ultrasound-Guided Fascia Iliaca Compartment BlockPROCEDURE

An ultrasound-guided infrainguinal fascia iliaca compartment block was administered with 30 mL of 1% lidocaine containing adrenaline.

TramadolDRUG

Tramadol was administered intravenously at a dose of 1 mg/kg before positioning for spinal anaesthesia.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18-60 years * Male or female patients * American Society of Anesthesiologists physical status I or II * Patients scheduled for femur fracture surgery under spinal anaesthesia Exclusion Criteria: * Multiple fractures * Peripheral neuropathy * Inability to communicate or provide reliable pain assessment * History of allergy to local anaesthetic agents * Contraindication to spinal anaesthesia, including: * Patient refusal * Local infection at the injection site * Coagulopathy

Outcomes

Primary Outcomes

Pain Intensity During Positioning for Spinal Anaesthesia

Pain intensity was assessed using a 0-10 visual analogue scale during placement of the participant in the lateral decubitus position before spinal anaesthesia. A score of 0 represented no pain, while a score of 10 represented the worst possible pain. Lower scores indicated better analgesic efficacy.

Time frame: 10 minutes after intravenous tramadol or 15 minutes after ultrasound-guided fascia iliaca compartment block, immediately before spinal anaesthesia.

Secondary Outcomes

Change in Visual Analogue Scale Pain Score From Baseline to Positioning

The change in pain intensity was determined by comparing the visual analogue scale score recorded while the participant was lying on the operating table before the assigned intervention with the score recorded during lateral decubitus positioning. A greater reduction in score indicated greater analgesic effectiveness.

Time frame: 10 minutes after intravenous tramadol or 15 minutes after fascia iliaca compartment block.