Comparing The Analgesic Efficacy Of Femoral Nerve Block And Sufentanil For Positioning Patients With Hip Fractures Before Subarachnoid Block

Objective:To observe and compare the analgesic efficacy of femoral nerve block(FNB) and intra-venous(IV) sufentanil to positioning for subarachnoid block in patients undergoing surgery for hip fracture.Methods:Sixty patients with hip fractures including 43 case of intertrochanteric fracture and 17 cases of femoral neck fracture, 39 males and 21 females, aged 50 to 80 years, weight50-85 kg, American Society of Anesthesiologists(ASA) physical status I to III, scheduled for surgical repair under spinal anesthesia were randomized into three groups. Fifteen minutes before positioning for subarachnoid block, the FNB group received nerve ultrasound guided FNB using 20 ml ropivacaine 0.5%(a mixture of 10 ml of ropivacaine1% and 10 ml of normal saline 0.9%). Five minutes before positioning, the S group received a dose of IV sufentanil 0.15μg/kg, the C group didn’t accept any intervention.The visual analog scale(VAS) following positioning(T2), adjusted OAA/S scale before positioning(T1), the MAP, HR, Sp O2 entering operating room(T0) and T1,T2 were recorded. The plasma concentration of noradrenaline(NA) and cortisol(Cor) by T0 and T2 were measured. The side effects or adverse reactions including respiratory depression,nausea vomiting, dizzy, were recorded. The experimental result was analyzed by SPSS22.0, P<0.05 was considered as statistically significant.Results:1. The comparison of demographics dateDemographics according to sex, age, weight, ASA physical status and the type of fracture were not significantly different among the three groups(P>0.05).2. The comparison of MAP, HR and Sp O2Compared with T0, the MAP and HR by T2 increased significantly in group C(P<0.05), while there were no obvious change in group F and group S(P>0.05); The obvious change of Sp O2 couldn’t be found at each time point in group C and F(P>0.05)while Sp O2 at T2 increased in group S(P<0.05); The comparison between groups had no statistical meaning(P>0.05).3. The comparison of VAS and adjusted OAA/SCompared with group C, group F and S showed markedly lower VAS at T2(P<0.05),there were no significant differences between group F and group S(P>0.05). The adjusted OAA/S of group S at T1 was higher than the other groups(P<0.05).4. The comparison of NA and CorCompared with T0, the level of NA and Cor by T2 rised obviously in group C(P<0.05), the significant variation of NA and Cor couldn’t be found in group F(P>0.05),the concentration of NA increased(P<0.05) and Cor had no change(P>0.05) in group S;the comparison between groups had no statistical significance(P>0.05).5. The side effectsSide effects or adverse reactions of group S included respiratory depression in 3patients, nausea vomiting in 1 and dizzy in 1, no adverse reaction were found in group C and group F.Conclusion:Both FNB and IV sufentanil can reduce the pain of positioning patients with fractured hip before spinal anesthesia. The analgesic efficacy is not significant difference between FNB and IV sufentanil. IV sufentanil has a sedative effect, the side effects must be considered. FNB which has no adverse reaction should be suggested.