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0.25% Bupivacaine with 8 mg Dexamethasone and 50 mcg Clonidine as adjuvant on fascia iliaca compartment block in open reduction and internal fixation surgeries to femoral fractures-a prospective randomized study

D Siva Prasad, Raja Damarla.


Abstract

Background: Fascia iliaca compartment nerve block (FICB) is commonly preferred pain management technique in femoral fractures. Dexamethasone and clonidine as adjuvants to local anesthetics have good analgesic effect with limited adverse effect.

Aim and Objectives: To assess the efficacy of bupivacaine with clonidine, bupivacaine with dexamethasone, and bupivacaine alone in fascia iliaca compartment block in cases with femoral fractures.

Materials and Methods: The present prospective randomized study included a total of 120 cases undergoing proximal femoral surgeries under subarachnoid block above 21 years. The study cases were randomly divided into three study groups, i.e. 40 participants in each group. Group 1 received 0.25% bupivacaine with 2 ml normal saline, Group 2 received 0.25% bupivacaine with 50mcg clonidine, and Group 3 received with 0.25% bupivacaine with 8mg dexamethasone. Parameters such as heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation levels, and visual analog scale (VAS) score was monitored and recorded.

Results: The mean difference of HR between the study groups was statistically not significant (P > 0.005). The mean SBP, DBP, and VAS score was comparable between study groups. The mean analgesic duration in Group 1 was 6.01 h, in Group 2 was 13.58 h, and in Group 3 was 14.44 h. The mean difference of rescue analgesia requirement and duration of rescue analgesia was statistically significant. No adverse effects toward drugs were noticed.

Conclusion: About 0.25% bupivacaine with 8 mg Dexamethasone had better analgesic duration and require minimal rescue analgesia in the first postoperative day than 0.25% bupivacaine with 50 mcg clonidine in cases undergoing femoral surgeries under FICB.

Key words: 0.25% Bupivacaine; Dexamethasone; Clonidine; Fascia Iliaca Compartment Block






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