Title: Comparison of Clonidine & Dexamethasone as Additive to Bupivacaine in Fascia Iliaca Compartment Block for Postoperative Analgesia in Patients Undergoing Lower Limb Orthopaedic Surgery
Authors: Sonali Dhawan, Mahboob Ali, Mohd Yunush Khilji
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.21
Abstract
Background & Aim: Major lower limb surgeries are associated with severe postoperative pain and requires good postoperative analgesia. The use of Fascia Iliaca Compartment Block (FICB) is a safe and effective approach to postoperative analgesia. The aim was to compare the efficacy of clonidine or dexamethasone as an adjuvant to bupivacaine in FICB for relieving postoperative pain in lower limb orthopaedic surgery.
Materials and Methods: In this prospective, randomized controlled study 100 patients of 18 to 65 years of age of either sex belonging to ASA Class I, II and III were randomly divided into 2 groups with 50 patients in each group. The study was conducted on elective cases of hip & femur shaft surgery under spinal anaesthesia. After completion of surgery FICB was given in supine position using loss of resistance technique. Group-1 received FICB with 38 ml of 0.25% bupivacaine + 50 mcg Clonidine diluted with Normal Saline up to 2 ml. Group-2 received FICB with 38 ml of 0.25% bupivacaine + 8mg Dexamethasone (2ml). All patients were assessed for postoperative pain using VAS score at 30 min,1,3,6,12,24 hours, total duration of postoperative analgesia and total rescue analgesics consumption in 24 hours.
Result: There was significant difference noted in both groups in terms of mean VAS score at rest and during movement at 12 hours after surgery. Mean VAS score at rest was 3.4±1.4 in Group-1 and 2.46±1.9 in Group-2 (P Value=0.006). Mean VAS score during movement was 4.84±0.99 in Group-1 and 4.22±1.49 in Group-2 (P Value=0.015). Total duration of postoperative analgesia was 11.2±2.19 hours in Group-1 compared to 12.44±2.54 hours in Group-2 which was statistically significant (p value=0.010). Mean requirement of number of rescue analgesics was 1.94±0.71 in Group-1 and 1.60±0.67 in Group-2, which was statistically significant (P Value=0.018).
Conclusion: We conclude that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolongs the duration of postoperative analgesia and decreases the requirement of rescue analgesics as compared to patients who received Clonidine (50mcg) as additive to Bupivacaine.
Keywords: Fascia Iliaca Compartment Block (FICB), Dexamethasone, Clonidine, postoperative analgesia.
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