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USE OF FEMORAL NERVE BLOCK TO HELP POSITIONING DURING CONDUCT OF REGIONAL ANAESTHESIA
CHANDRAKANT P GOSAVI*, LS CHAUDHARI**,RASHMI PODDAR***
*Registrar, KB Bhabha Hospital, Kurla - 400 070; **Prof. in Anaesthesia, KEM Hospital, Parel, 400 012; ***Anaesthetist, Lotus Eye Hospital, VN Desai Hospital, Mumbai.
Forty patients were evaluated to find out the efficacy of femoral nerve block in providing pain relief caused by movement of fractured limb during conduct of regional anaesthesia. All patients were given femoral nerve block using Khoo and Brown method. Patients included in study had fracture of shaft or neck of femur. Femoral nerve block is safe, simple and effective in relieving pain and muscle spasm caused by fractured bone. No systemic side effects were observed and haemodynamic stability was well maintained in patients with moderate general condition.
INTRODUCTION
We report our experience of femoral nerve block as a means of producing local analgesia for positioning comfort during conduct of regional anaesthesia. Periosteum is a very sensitive structure. It derives its nerve supply from nerves of overlying skin and nearby muscles attached to it. In case of femur, the nerve supply to periosteum comes from nerves to quadriceps femoris muscle i.e. femoral nerve, root value is L2-3-4. [1]
MATERIAL AND METHODS
Forty patients age ranging from 20 years to 90 years, with ASA status one to three having fracture of femur at various levels i.e. neck and shaft were selected for the study. Femoral nerve block was done by Khoo and Brown method. [2] Femoral nerve can be blocked as it emerges from abdomen behind inguinal ligament, in femoral triangle, where the nerve lies lateral to the femoral artery and deep to fascia iliaca and fascia lata. The anaesthesiologist stands on same side of the patient to fractured limb. Palpates anterior superior iliac spine, pubic tubercle and visualizes inguinal ligament. Femoral artery is palpated just below the inguinal ligament. At a distance one to two cms lateral to the artery a small gap between muscle iliacus and psoas is felt. A short beveled 23-gauge needle is vertically inserted over the point. After getting the give way feeling of penetrating the fascia, with or without eliciting the paraesthesia, careful aspiration is done to rule out intravascular placement of the needle. 15 ml of the solution (10 ml of 2% lignocaine + 1 ml of sodium bicarbonate + 4 ml of normal saline) was injected. After waiting for 10 minutes, cutaneous anaesthesia was checked by pinprick. Severity of pain as noted on visual analogue scale (VAS) ranging from zero to 10. Ten showing the maximum and zero measuring no pain. Corresponding to it analgesia was noted. Patient was then given sitting position. Analgesia was noted while making patient in a sitting from supine position for giving epidural and spinal anaesthesia. Analgesia was also noted at the second change of position i.e. making patient supine after giving regional anaesthesia. Time required for conduct of epidural and spinal anaesthesia was noted. Patient’s version of analgesia during the period of procedure of regional anaesthesia and at change of movement on two occasions was noted.
Mean
Standard Deviation
Age in years 56.4 19.04 Onset of action of block (Mins) 5 0.54 Analgesia at change of position-1 (VAS) 2.7 1.1 Analgesia at change of position-2 (VAS) 2.17 1.1 Time required for procedure (Regional anaesthesia) in mins. 25.56 7.78 RESULTS AND DISCUSSION
To date we have used this technique with complete success on 40 patients with fracture of femur. The average onset of analgesia was 5 (+ 0.54) mins. Analgesia at first change of position was 2.7 (+ 1.1) on VAS. Analgesia at the second change of position was 2.1 (+ 1.1) on VAS. Average duration for conduct of regional anaesthesia was 25.56 (+ 7.78) mins. Most of the patients rated analgesia as good to excellent. We have not experienced any failures of analgesia and have been impressed by its remarkable effect in providing comfort during change of position, which is required for conduct of regional anaesthesia. We have not experienced any complications, apart from inadvertent puncture of the femoral artery on two occasions. This has not been followed by any untoward sequelae, perhaps because of the small gauge of the needle. We have found femoral nerve block such a successful technique that we now use it for relieving pain caused by movement of fractured limb during positioning.
A study by Berry FR; Denton JS and Manning MPRA has shown that femoral nerve block is an effective method of pain relief in patients with fracture shaft femur, which helps in easy manipulation, transportation and radiological procedures. [3,4] Same analgesia supplemented with light general anaesthesia or regional anaesthesia provides satisfactory anaesthesia for surgical procedures. [5]
REFERENCES
1.Last RJ. Anatomy : regional and applied, 5th edition. Page no 18. Churchill Livingstone, London.
2.Khoo ST, Brown TCK. Femoral nerve block - the anatomical basis for a single injection technique. Anaesth and Intents Care 1983; 11 : 40-2.
3.Berry FR. Analgesia in patients with fractured shaft of femur. Anasthesia 1977; 32 : 576-7.
4.Denton JS, Manning MPRA. Femoral nerve block for femoral shaft fractures in children. Brief report. J Bone Joint Surgery 1988; 70-B : 84.
5.McGlone R, Sadhar K. Femoral nerve block in the initial management of femoral shaft fractures. Arch Emerg Med 1987; 4 : 163-8.
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