A Comparative Study between Femoral Nerve Block and Intravenous Ketamine in Pain Management for Septuagenarian and Octagenerian Patients with Femur Fracture during Positioning before Spinal Anesthesia

Abstract Background Femur fracture commonly occurs following trauma in elderly patients and central neuraxial block especially spinal anesthesia is more preferred for providing anesthesia for such cases. Proper positioning during spinal anesthesia is a must for a successful procedure, but extreme pain and limb immobility are obstacles for an ideal position for this procedure. Different methods like intravenous fentanyl, ketamine, femoral nerve block or fascia iliaca block have been used to control the pain pre-operatively and improve these patients' positioning. Aim of the Work To investigate the effect of Ultrasound guided FNB using 0.25% bupivacaine versus IV analgesic ketamine dose (0.25 mg/kg) in pain control for positioning before spinal anesthesia in patients undergoing surgery for fractured femur. In addition to recording postoperative analgesic effect, postoperative opioid consumption and rate of complications Patients and Methods The study was conducted on 60 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee Results Results of the study revealed that FNB analgesia was more effective than IV analgesic dose of ketamine for pain control during positioning. The first call for rescue analgesia (morphine), total morphine consumption and postoperative pain scores indicated that the superiority of the FNB technique with opioid sparing effect and lesser complications. Conclusion Unlike preoperative intravenous ketamine analgesia, preoperative FNB provided better pain control during positioning for spinal blockade in fractured femur patients. Furthermore, FNB was associated with less adverse effects, better postoperative analgesia and less postoperative opioid consumption.