Comparison of Ultrasound-Guided Femoral Nerve Block and Intravenous Fentanyl For Analgesia During Positioning of Patients With Femur Fracture for Combined Spinal-Epidural Anesthesia: A Randomized Controlled Study

Background Central neuraxial blockade is the preferred anesthesia technique for femur fracture surgeries. However, positioning patients for neuraxial anesthesia can be challenging due to severe pain. Analgesic strategies, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, non-opioid analgesics, and nerve blocks like lumbar plexus, fascia iliaca, three-in-one, and femoral nerve blocks (FNBs), are used to ease positioning. This study compared the analgesic efficacy of intravenous (IV) fentanyl and ultrasound-guided FNB using visual analogue scale (VAS) scores in patients with femur fractures undergoing combined spinal-epidural (CSE) anesthesia. Methodology Sixty-four American Society of Anesthesiologists (ASA) physical status I/II adult patients were randomized into two groups (n = 32). Group A received IV fentanyl (1 mcg/kg), while Group B received FNB with 20 mL of 0.25% bupivacaine under ultrasound guidance. Patients were positioned for CSE anesthesia. VAS scores and hemodynamic parameters were recorded at rest (V1), during movement (V2), and at 5 (V3), 10 (V4), and 15 (V5) minutes post-intervention. Results Demographics and hemodynamics were comparable between groups. Both groups showed significant VAS score reduction with no statistically significant difference at any time point (V1-V5, p > 0.05). The mean time to position patients was 4.25 ± 1.68 minutes in Group A and 3.63 ± 1.87 minutes in Group B (p = 0.166). The time for CSE administration was also similar (p = 0.861). Conclusion IV fentanyl is as effective as ultrasound-guided FNB for pain relief during patient positioning for CSE anesthesia in femur fracture surgeries. Ultimately, both methods are valuable analgesic strategies for facilitating patient positioning and improving the overall safety and comfort during the administration of central neuraxial anesthesia. The choice of intervention can be tailored based on individual patient characteristics, institutional protocols, and resource availability.