Comparative Study of Analgesic Efficacy of Ultrasound Guided Femoral Nerve Block versus Intravenous Fentanyl Injection in Fracture Femur Patients at Emergency Department

Abstract

Aim: The aim of this work was to evaluate the analgesic efficacy of ultrasound guided femoral nerve block compared with intravenous (IV) fentanyl in fractures of the femur in patients presented to Emergency Department (ED). Methods: This prospective, comparative, (blinded, randomized controlled clinical trial) was conducted on fifty patients with femur fracture. Patients were divided into two equal groups: group A underwent ultrasonography-guided femoral nerve block and group B given IV fentanyl 2 µg/kg). All patients underwent initial resuscitation. Intra-venous (IV) access with wide bore cannula and baseline investigation were obtained. Patients underwent X-ray imaging for diagnosis of femur fracture and FAST (Focused Assessment with Sonography for Trauma) scan on presentation at ED by ED trained physicians. Results: There is significant difference in group B as regard to peripheral oxygen saturation (SpO2) and Systolic blood pressure (P <0.001 and 0.013 respectively).  VAS (median ± SD) was lesser in group A 4.16 ± 2.12 VS 4.96 ± 2.05 in group B. Pain intensity difference was significant decrease group A over time (P= 0.032). Requesting analgesia and rescue analgesia were insignificant different between two groups. Conclusions: Both femoral nerve block and IV fentanyl are effective in relieving pain in patients with femur fractures. But femoral nerve block provides better and intense analgesia, and major pain intensity difference in less time. Moreover, use of FNB had fewer side effects and more hemodynamicsstability as compared to opioids.