Fascia iliaca block versus intravenous dexmedetomidine and ketamine for positioning fracture femur patients during spinal anesthesia: Randomized comparative study

Background: Patients suffering from femur fractures experience excruciating agony, making it difficult to position them for spinal anesthesia. Aim: To evaluate the efficacy of intravenous dexmedetomidine-ketamine versus ultrasound-guided fascia iliaca block (FIB) in reducing positional pain in patients undergoing spinal anesthesia for femur fractures respectively. Method: This prospective randomized study included sixty-six patients, ages forty to eighty years subjected to femur fracture surgery. patients were randomly assigned to one of two groups. One group received intravenous doses of dexmedetomidine (0.25 μg/kg) and ketamine (0.2 mg/kg). the other one was given a fascia iliaca block with 0.5 ml/kg of 0.25% bupivacaine. We evaluated the behavioral pain scale as a primary outcome and the patient's posture, anesthetist satisfaction, patient satisfaction and incidence of any side effects as a secondary outcome. Results: FIB group demonstrated significantly lower pain scores (p0.039), better positioning quality (p0.029), and higher anesthetist (p0.028) and patient satisfaction (p0.038) than dexmedetomidine-ketamine group. Dexmedetomidine-ketamine group showed significantly lower heart rates than FIB group and experienced more systemic side effects, while FIB group only reported three cases of hematoma. Conclusion: While both methods demonstrated efficacy, fascia iliaca block offered superior pain control, positioning quality, satisfaction measures, and no systemic side effects compared to intravenous ketamine- dexmedetomidine for positioning fracture femur patients during spinal anesthesia.