Patient-controlled fascia iliaca compartment block versus fentanyl patient-controlled intravenous analgesia in patients undergoing femur fracture surgery

Background and objectives
Postoperative pain relief is crucial in elderly, however, the use of opioids is limited owing to their potential side effects. We studied the effects of patient-controlled ultrasound guided fascia iliaca compartment block (FICB) with Levobupivacaine versus patient-controlled intravenous fentanyl on postoperative pain score in patients scheduled for fixation of femur fractures under general anesthesia.
Methods
60 patients ASA physical status I and II undergoing elective fixation of fracture femur were enrolled in this randomized study into two groups. patients received fentanyl 20µg/ml solutions through a PCA pump programmed to give a basal infusion of 10µ/h and bolus doses of 2ml/dose with a 15min lockout interval. PCA was adjusted to deliver a continuous basal infusion of 4ml/h levobupivacaine 0.125% and 2ml demand boluses with a lockout interval of 15min. Visual analogue score (VAS) and total postoperative rescue analgesic consumption were assessed.
Results
VAS scores were significantly lower in PC-FICA group compared to PC-IVF group at 1h, 3h and 6h postoperative. 7 patients requested post-operative rescue analgesia in PC-FICA group compared to 19 patients in PC-IVF group. Total consumption of rescue analgesia was significantly decreased in PC-FICA group (31.4 ± 10.7mg) compared to PC-IVF group (70.5 ± 20.4mg) (P< .05).
Conclusion
PC-FICA provided a better quality of analgesia and decreased postoperative rescue analgesic requirement without increased side effects compared to PCA IV fentanyl.