Abstract
Background & Aim: Major lower limb surgeries are associated with severe postoperative pain and requires good postoperative analgesia. The use of Fascia Iliaca Compartment Block (FICB) is a safe and effective approach to postoperative analgesia. The aim was to compare the efficacy of clonidine or dexamethasone as an adjuvant to bupivacaine in FICB for relieving postoperative pain in lower limb orthopaedic surgery.
Materials and Methods: In this prospective, randomized controlled study 100 patients of 18 to 65 years of age of either sex belonging to ASA Class I, II and III were randomly divided into 2 groups with 50 patients in each group. The study was conducted on elective cases of hip & femur shaft surgery under spinal anaesthesia. After completion of surgery FICB was given in supine position using loss of resistance technique. Group-1 received FICB with 38 ml of 0.25% bupivacaine + 50 mcg Clonidine diluted with Normal Saline up to 2 ml. Group-2 received FICB with 38 ml of 0.25% bupivacaine + 8mg Dexamethasone (2ml). All patients were assessed for postoperative pain using VAS score at 30 min,1,3,6,12,24 hours, total duration of postoperative analgesia and total rescue analgesics consumption in 24 hours.
Result: There was significant difference noted in both groups in terms of mean VAS score at rest and during movement at 12 hours after surgery. Mean VAS score at rest was 3.4±1.4 in Group-1 and 2.46±1.9 in Group-2 (P Value=0.006). Mean VAS score during movement was 4.84±0.99 in Group-1 and 4.22±1.49 in Group-2 (P Value=0.015). Total duration of postoperative analgesia was 11.2±2.19 hours in Group-1 compared to 12.44±2.54 hours in Group-2 which was statistically significant (p value=0.010). Mean requirement of number of rescue analgesics was 1.94±0.71 in Group-1 and 1.60±0.67 in Group-2, which was statistically significant (P Value=0.018).
Conclusion: We conclude that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolongs the duration of postoperative analgesia and decreases the requirement of rescue analgesics as compared to patients who received Clonidine (50mcg) as additive to Bupivacaine.
Keywords: Fascia Iliaca Compartment Block (FICB), Dexamethasone, Clonidine, postoperative analgesia.
References
- Srivastava U, Kumar A, Saxena S, Naz A, Goyal V, Mehrotra R. Lumbar plexus block for postoperative analgesia following hip surgery: A comparison of ‘3 in 1’ block and psoas compartment block. Indian J. Anaes 2007; 51:127-30
- Ganapathy S, Wasserman RA, Watson JT, Bennett J, Armstrong KP, Stockall CA, et al. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. AnesthAnalg 1999; 89:1197-202.
- Wallace JB, Andrade JA, Christensen JP, Osborne LA, Pellegrini JE. Comparison of fascia iliaca compartment block and 3-in-1 block in adults undergoing knee arthroscopy and meniscal repair. AANA J. 2012; 80(4 Suppl): S37-44.
- Saied NN, Gupta RK. Dexamethasone and Clonidine, but not Epinephrine, Prolongs Duration of Ropivacaine in Brachial Plexus Blocks, Cross-Sectional Analysis in Outpatient Surgery Setting. Am Acad Pain Med. 2017; 18:2013-2026.
- Kumar S, Kiran N, Ravi M, Sebastian D, RM PG. Dexamethasone as an additive to bupivacaine in fascia lliaca compartment block: a prospective, randomized and double blind study. Journal of clinical and diagnostic research: JCDR. 2014 Aug; 8(8): GC05.
- Cummings KC 3rd, Napierkowski DE, Parra-Sanchez I, Kurz A, Dalton JE, Brems JJ, et al Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth. 2011; 107: 446–53.
- Bafna U, Yadav N, Khandelwal M, Mistry T, Chatterjee CS, Sharma R. Comparison of 0.5% ropivacaine alone and in combination with clonidine in supraclavicular brachial plexus block, Indian journal of pain.2015;29(1):41-45.
- Patil KN, Singh ND. Clonidine as an adjuvant to ropivacaine-induced supraclavicular brachial plexus block for upper limb surgeries. J Anaesthesiol Clin Pharmacol. 2015; 31(3):365-9.
- Tomar GS, Tiwari A, Agrawal S, Sethi A, Kriplani TC. Role of Clonidine in Fascia Iliaca Compartment Block for Preoperative Analgesia in Post Hip Fracture Patients: A Comparative Study. J Anesthe Clinic Res. 2011; 2(121):2.
- Sharma Uma Datt, Prateek and TH. Effect of addition of dexamethasone to ropivacaine on post-operative analgesia in ultrasonography-guided transversus abdominis plane block for inguinal hernia repair_ A prospective, double-blind, randomised controlled trial. 2018; 62(5):371–375.
- Mehra DC, Wani DZ, Sharma DM. Role of dexamethasone in brachial plexus block. Int J Sci Res. 2018; 7(1).
- Rambabu S, Srinivas M, Santhi M. A Comparative Study of Clonidine Vs Dexamethasone as Adjuvants with Local Anaesthetic in Supraclavicular Brachial Plexus Block.”. “IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). (2018); Volume 17, Issue 2 PP 55-64.
Corresponding Author
Mahboob Ali
Resident, Department of Anaesthesia, Sardar Patel Medical College & AGH, Bikaner, Rajasthan
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.21
