Intrathecal Morphine versus Fascia Iliaca Compartment Block for Post Operative Pain Control in Femur Fracture: A Randomised Controlled Prospective Study

Background : Fracture femur leads to considerable pre and post-operative pain which is one of the most common medical causes of delayed recovery and discharge [1]. Optimal pain control not only decrease complications but also facilitates faster recovery during the immediate postoperative period. Fascia iliaca compartment block (FICB) is a regional block of lumbar plexus which is an alternative to central neural block and can provide adequate unilateral analgesia with fewer adverse effects. Hence we conducted the study to compare the efficacy of FICB to that of Intrathecal Morphine administration in fracture femur cases with regards to the duration of analgesia, patient satisfaction and side effect profiles. Material and Method: The study is a prospective, randomized, double blinded study. 80 patients were divided into 2 groups. Group ITM (Group A) received 0.5% Bupivacaine (heavy) with 150 mcg of morphine as an adjuvant after CSF aspiration, then patient was made to lie in supine position. Group FICB (Group B) -patients received spinal anaesthesia with 3ml of 0.5% Bupivacaine (heavy) and later facia iliaca block was given with USG guidance after confirmation of correct needle position, with 20ml of 0.5% Bupivacaine and 20ml of 2% xylocaine with adrenaline. Patients were monitored for post-operative pain scores, tramadol consumption, vital parameters including heart rate, blood pressure, oxygen saturation and adverse effects like nausea vomiting, itching, respiratory depression and sedation at 1,2,4,6,12 and 24 hrs. Results: The mean NRS score at 1,2 and 4 hours were not statistically significant and had nearly equal NRS score. However at 6, 12 and 24 hour the mean NRS score was statistically significant and lower in group A than in Group B. The mean time to first rescue analgesia in Group A was 18.75±1.81 hrs and in Group B 10.53±1.54 hrs (p=0.000) which was statistically significant. The overall patient satisfaction score at 12 hours and 24 hours postoperatively was found to be considerably higher in Group B ...