Fascia Iliaca Block with Ketamine as Adjuvant for Postoperative Analgesia after Knee and Femoral Shaft Orthopedic Surgeries
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This study was designed to assess the analgesic outcome of preemptive fascia iliaca compartment block (FJCB) using a mixture of local anesthetics and kelamine as a modality to provide extended postoperative analgesia after orthopedic surgeries of the femur and knee. Patients & Methods: The study included 50 patients randomly divided into 2 groups. (n=25); received FICB using bupivacaine 0.25% with 1,200,000 adrenalin (Control group) and received 10 mg ketamine as adjuvant to local anesthetic (Study group). Sensory blockade was evaluated using pinprick test every 10 min for 30 min after injection and at T-30 min, blockade was considered complete when anesthesia spread to the lateral femoral cutaneous (LFC), femoral (Fern) and obturator (Obt) nerves; incomplete if the spread was not concomitant to all three nerves; and absent if none of the three nerves was anesthetized. Postoperative pain sensation was evaluated every 30-min using a semi-quantitative five-step verbal pain score and duration of analgesia was defined as the time since T-30 min till start of pain sensation. Results; All procedures were conducted safely; only 2 patients had mild nonexpanding hematoma; one patient showed block failure. Both groups showed time course progressive increase of the number had sensory blockade with varied nerve blockade percentage. At 30-T evaluation, Fern nerve blockade was reported in 47 patients (94%), LFC nerve blockade in 76% and Obt nerve blockade in 50%. There was a non-significant difference between both groups as regards the percentages of patients had sensory blockade. Mean duration of sensory blockade was significantly longer and pain scores were significantly lower in study compared to control group with . significantly lower number of requested rescue analgesia. At end of 12-hr follow-up, 17 patients were discharged pain-free, while 33 patients had mild pain with significant diffe^ence in favor of study group. Conclusion: FICB is a safe and effective procedure that could . be conducted without the need for nerve stimulator with success rate of 98% and accuracy of block of 94% and adjuvant ketamine provided extended postoperative analgesia for 12 hours after block allowing similar procedures to be conducted as one-day surgery.