Comparison of Ultrasound Guided Femoral Nerve Block and Fascia Iliaca Compartment Block for Pain Relief During Positioning and Postoperative Analgesia in Proximal Femur Fracture

Introduction: Proximal femur fractures are usually associated with pain, which poses a challenge for patient positioning for subarachnoid block (SAB). The femoral nerve block (FNB) which is a regional anaesthetic technique such as and fascia iliaca compartment block (FICB) are widely utilised to alleviate this pain. While both the techniques are efficient, there is limited comparative data regarding their efficacy under ultrasound guidance. Materials and Methods: This observational comparative study included 44 adult patients who undergo elective surgery for isolated proximal femur fractures under spinal anaesthesia. The study participants were divided into two groups: Group 1 (n = 22) who received ultrasound-guided FNB with 20 mL of 0.25% Ropivacaine, and Group 2 (n = 22) who received ultrasound-guided FICB with 30 mL of 0.25% Ropivacaine. Pain was assessed using a 10 cm Visual Analog Scale (VAS) before the block and at 5-minute intervals up to 40 minutes post-block. Patients were positioned for SAB when VAS < 3. Results: VAS scores were comparable between the groups up to 10 minutes after block administration. From 15 to 35 minutes, the FNB group showed significantly lower VAS scores compared to the FICB group (p < 0.05), indicating a faster onset of analgesia. The mean time for VAS to regress to 3 was significantly shorter in the FNB group (29.32 ± 3.87 minutes) compared to the FICB group (35.00 ± 3.45 minutes; p < 0.001). Conclusion: Both ultrasound-guided FNB and FICB are effective in managing preoperative pain during positioning for SAB in patients with proximal femur fractures. FNB offers a faster onset of analgesia, making it preferable for early positioning, while FICB provides longer-lasting postoperative pain relief. The choice of block can be tailored to meet specific perioperative analgesic goals.