Comparison of efficacy of fascia iliaca compartment block using ropivacaine versus ropivacaine with dexmedetomidine versus ropivacaine with dexamethasone for acute pain relief in patients with femoral fractures: A prospective randomized controlled study

Context: Landmark-guided fascia iliaca compartment block (FICB) has been used in operation theater to facilitate patient position before administration of subarachnoid block, but its utilization is yet to be explored in the accident and emergency department for acute pain relief in patients with femoral fractures. Aims: The study aims to compare dexmedetomidine and dexamethasone as adjuvants to ropivacaine for FICB for onset and duration of analgesia. Settings and Designs: This was a prospective randomized controlled study performed in Mahatma Gandhi Memorial Medical College, Indore. Subjects and Methods: Ninety patients with femoral factures were allocated into three groups, and each group received 15 ml of study drug; (i) ropivacaine with dexmedetomidine (RD) group (0.2% ropivacaine with 50 μg dexmedetomidine), (ii) ropivacaine with dexamethasone (RM) group (0.2% ropivacaine with 4 mg dexamethasone), and (iii) ropivacaine alone (RP) group (0.2% ropivacaine). Patients were assessed for onset, duration of analgesia, and need for rescue analgesic. Severity of pain was assessed using Numerical Rating Scale (NRS) score. Statistical Analysis Used: Comparison of means of three groups was done using One-Way ANOVA and pair-wise comparisons using post hoc Tukey's test. Results: The onset of analgesia was earlier in Group RD at 4.38 min followed by Group RM at 4.45 min and Group RP at 7.86 min, whereas the duration of analgesia was longer in Group RD at 725 min followed by Group RM at 594 min and Group RP at 275 min. NRS Score was comparable before application of FICB. After the block, the mean NRS score in Group RD was 3.83, in Group RM was 5.30, and in Group RP was 7.93. Conclusions: FICB is an effective alternative to intravenous opioids and nonsteroidal anti-inflammatory drugs for acute pain relief in patients with femoral fractures, and dexmedetomidine and dexamethasone can be used as adjuvants to ropivacaine as they both enhance quality of block.