Comparison of pre-spinal regional analgesic techniques for positioning in proximal femur fractures

Abstract

Background: Proximal femur fractures are very painful. Positioning of these patients for subarachnoid block causes lot of discomfort to them. Various modes of analgesia have been used to alleviate this pain. We compared 2 such modalities – femoral nerve block (FNB) and fascia iliaca compartment block (FICB), guided by ultrasound in 50 patients randomly assigned to the two groups, FNB and FICB.

Methodology: Group FNB received an in-plane USG-FNB with 15 mL of a 1:1 mixture of 0.25% levobupivacaine and 2% lignocaine with adrenaline (1:200000). Group FICB received an in-plane USG-FICB with 30 mL of a 1:1 mixture of 0.25% levobupivacaine and 2% lignocaine with adrenaline (1:200000). After fifteen minutes of the analgesic intervention, the patient was positioned for subarachnoid block. Pain was assessed using the Numerical Pain Rating Score (NPRS), along with time to loss of pin prick sensation, number of pricks, and time taken for subarachnoid block. Patient satisfaction scores were also noted.

Results: The NPRS scores at positioning, the total reduction in the NPRS scores, time at loss of pin-prick sensation, and the number of subjects requiring rescue analgesia were similar in both groups with P-value of 0.641, 0.376, 0.243, 0.167 and 0.305 respectively. NPRS score at 5 minutes in Group FNB was 4 and in Group FICB was 5 with p -value of 0.03 and at 10 minutes, score was 3 and 4 in Group FNB and Group FICB respectively with P-value of 0.01. However, during patient positioning, the analgesic effects were comparable. Patient satisfaction was also comparable in both groups.

Conclusion: Although both USG-FNB and USG-FICB have comparable total reduction in the NPRS scores, the reduction in pain is faster with the femoral nerve block.

Abbreviations: FNB: femoral nerve block, FICB: fascia iliaca compartment block, NPRS: Numerical Pain Rating Score

Keywords: Proximal femur fractures; Regional analgesia; Ultrasound-guided nerve block; Patient positioning; Patient satisfaction; Spinal anesthesia

Citation: Pai AP, Bhat RRK, Kulkarni M, Shenoy L, Kanakalakshmi ST. Comparison of pre-spinal regional analgesic techniques for positioning in proximal femur fractures. Anaesth. pain intensive care 2025;29(9):1164-70. DOI: 10.35975/apic.v29i9.3047

Received: August 20, 2025; Revised: October 26, 2025; Accepted: December 01, 2025