الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 119 |  |  |
| | | from | 119 | | |
Abstract
Fractured neck of femur is a common cause of admission among the elderly population. Regional analgesia has been expected to be superior to systemic opioids in management of postoperative pain. Fascia iliaca compartment block (FICB) is one of the recent peripheral nerve block techniques. It became widely used in providing postoperative analgesia for patient with FNF either in emergency department or in the operating room, also QLB is a new, safe technique which has found its place in multimodal postoperative pain therapy in orthopedic interventions on hips.This study, aimed at comparing the ultrasound guided QLB type I versus the ultrasound guided FICB as regard efficacy of the block to produce analgesia, perioperative hemodynamic changes, first analgesic requirement after the block, total analgesic requirement in the 1st 24 h, and any complications in the 1st 48 h postoperative. Forty five patients (ASA) physical status I - III of both sexes aged from 55-75 scheduled for elective FNF surgery, were allocated into two groups (Q group and F group) with 27 patient in each one: NRS was explained to all patients and basal NRS, HR, MAP were recorded. Each block was performed by injecting 30 mL of 0.375% bupivacaine under ultrasound guidance at the side of fracture. Quadratus block was done by injecting LA on the lateral side of QLM (at the level where TAM tapers off into its aponeurosis) and FICB was done by injecting LA between fascia iliaca layer and iliopsoas muscle, then 30 min after the block NRS was assessed, after that the patient was positioned for spinal anesthesia and the satisfaction score was recorded.Our results proved that both FICB and QLB are effective regional anesthetic techniques which can provide good postoperative analgesia after FNFs. However, QL group is more effective than FI group which was obvious by significant reduction of NRS in QL group than FI group, statistically significant longer time to the 1st analgesic requirement, and significant reduction of total analgesic consumption of either rescue analgesic or fentanyl in QL group than FI group. There were no statistically significant difference in hemodynamic changes between both groups. However, there was initial hypotension and tachycardia in the two studied groups related to the autonomic effect of spinal anesthesia, there were no reported complications in the two studied groups. In conclusion both regional anesthetic techniques either QLB type 1 or FICB can provide good to excellent postoperative analgesia in patients with FNF and decrease rescue analgesic consumption. However QLB type I is more effective with longer duration of action and lower analgesic consumption than FICB but more clinical trials are required to validate this.