Fascia iliaca block versus intravenous dexmedetomidine and ketamine for positioning fracture femur patients during spinal anesthesia: Randomized comparative study

Hetta, Hassan Mokhtar; Khairy, Amany; Sobhy, Zeinab Saleh; Mostafa, Mohamed

doi:10.21608/mjmr.2024.307092.1762

Fascia iliaca block versus intravenous dexmedetomidine and ketamine for positioning fracture femur patients during spinal anesthesia: Randomized comparative study

Articles in Press

Document Type : Original Article

Authors

¹ anaethesia and intesive care department , minia university

² Department of Anesthesia, El-Minia Faculty of Medicine

³ anesthesia and ICU department, Minia university

⁴ anathesia and intensive care department, faculty of medicine , minia university

10.21608/mjmr.2024.307092.1762

Abstract

Background: Patients suffering from femur fractures experience excruciating agony, making it difficult to position them for spinal anesthesia.

Aim: To evaluate the efficacy of intravenous dexmedetomidine-ketamine versus ultrasound-guided fascia iliaca block (FIB) in reducing positional pain in patients undergoing spinal anesthesia for femur fractures respectively.

Method: This prospective randomized study included sixty-six patients, ages forty to eighty years subjected to femur fracture surgery. patients were randomly assigned to one of two groups. One group received intravenous doses of dexmedetomidine (0.25 μg/kg) and ketamine (0.2 mg/kg). the other one was given a fascia iliaca block with 0.5 ml/kg of 0.25% bupivacaine. We evaluated the behavioral pain scale as a primary outcome and the patient's posture, anesthetist satisfaction, patient satisfaction and incidence of any side effects as a secondary outcome.

Results: FIB group demonstrated significantly lower pain scores (p0.039), better positioning quality (p0.029), and higher anesthetist (p0.028) and patient satisfaction (p0.038) than dexmedetomidine-ketamine group. Dexmedetomidine-ketamine group showed significantly lower heart rates than FIB group and experienced more systemic side effects, while FIB group only reported three cases of hematoma.

Conclusion: While both methods demonstrated efficacy, fascia iliaca block offered superior pain control, positioning quality, satisfaction measures, and no systemic side effects compared to intravenous ketamine- dexmedetomidine for positioning fracture femur patients during spinal anesthesia.

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