Ultrasound-guided Fascia Iliaca Compartment Block In Patients Undergoing Femoral Intertrochanteric Fracture Surgery:a Randomized Controlled Trial

The purpose of current study is to investigate the analgesic effect of FICB compared with intravenous flurbiprofen axetil and identify the median effective volume of 0.3% ropivacaine in the old patients with femoral intertrochanteric fracture.Part I: The analgesic effect of different methods during posture change in the old patients with femoral intertrochanteric fractureObjective: To investigate the analgesic effect of ultrasound-guided FICB during posture change compared with intravenous flurbiprofen axetil.Methods: Eighty old patients with femoral intertrochanteric fracture undergoing selective surgery,aged 52~78 y old,ASA I~III,during January,2014 to December,2015 were enrolled.Patients were randomly assigned to ultrasound-guided FICB(Group A,n=40)or intravenous flurbiprofen axetil group(Group B,n=40).Patients in Group A were received ultrasound-guided FICB procedure by using 30 ml of 0.3% ropivacaine 30 min before the induction of anesthesia,while patients in Group B were received 50 mg of intravenous flurbiprofen axetil.Visual analogue scale(VAS)and mean arterial pressure(MAP)were recorded at 30 min after FICB or intravenous flurbiprofen axetil(T1),the moment when patients transferred to the operating bed(T2),and the moment when patients transferred to the vehicle after operation(T3).Results: VAS in Group A was lower than Group B at each time point(Group A vs.Group B: T1: 3.5 ± 0.72 points vs.6.0 ± 0.78 points;T2: 4.8 ± 0.76 points vs.7.9 ± 0.80 points;T3: 2.8 ± 0.73 points vs.5.2 ± 0.68 points)(P < 0.01).MAP in Group A was lower than Group B at each time point(Group A vs.Group B: T1: 83.2±2.94 mm Hg vs.85.7±2.94 mm Hg;T2: 94.0±5.43 mm Hg vs.103.0±3.81 mm Hg;T3: 70.8±4.90 mm Hg vs.82.1±3.86 mm Hg)(P < 0.01).Conclusion: FICB is a superior method displayed a better analgesic effect during posture change compared with intravenous flurbiprofen axetil in the old patients with femoral intertrochanteric fracturePart II: The median effective volume of 0.3% ropivacaine using ultrasound guided FICB in the old patients with femoral intertrochanteric fractureObjective: To identify the median effective volume of 0.3% ropivacaine using ultrasound guided FICB during posture change in the old patients with femoral intertrochanteric fracture.Methods: Thirty-nine old patients with femoral intertrochanteric fracture undergoing selective surgery,aged 64~98 y old,ASA II~III,BMI 19.2~23.6 kg/m2,during January,2016 to December,2016 were enrolled.Patients were sequentially received a pre-set volume of 0.3% ropivacaine.The initial volume was set and 40 ml was considered as the maximum volume according to our pilot study.The ratio between each volume was 1.13.A sign of “+” was marked since the patient presented positive to FICB,and the next patient would be assigned to a lower volume of ropivacaine.Otherwise,a sign of “-” was marked since the patient presented negative to FICB,and the next patient would be assigned to a larger volume of ropivacaine.The trial would be terminated when 7 inflection points occurred.The median effective volume of 0.3% ropivacaine with 95% confidence interval(CI)was calculated according to sequential method.Results: Twenty in a total of 39 patients received a successful ultrasound guided FICB.The median effective volume of 0.3% ropivacaine using ultrasound guided FICB in the old patients with femoral intertrochanteric fracture is 25.37 ml,95% CI(22.06 ml,29.19 ml).Conclusion: The median effective volume of 0.3% ropivacaine using ultrasound guided FICB in the old patients with femoral intertrochanteric fracture is 25.37 ml.