Nghiên cứu hiệu quả giảm đau của phương pháp gây tê mạc chậu dưới hướng dẫn siêu âm so với morphin khoang dưới nhện sau phẫu thuật gãy đầu trên xương đùi

Proximal femoral fractures are a prevalent orthopedic issue, particularly among the elderly, leading to significant acute postoperative pain. Effective pain management is crucial for facilitating early mobilization, promoting recovery, and mitigating complications such as delirium, which is markedly increased in elderly patients with poorly controlled pain. While intrathecal Morphine has been a conventional approach for postoperative analgesia, its use is associated with considerable adverse effects, including urinary retention, nausea, and potentially severe respiratory depression, especially in vulnerable populations. This context underscores the critical need for alternative, safer, and equally efficacious pain control strategies. This study aims to compare the analgesic efficacy and adverse effects of ultrasound-guided fascia iliaca compartment block against intrathecal Morphine in patients undergoing proximal femoral fracture surgery.

Anesthesiologists, orthopedic surgeons, pain management specialists, and researchers interested in regional anesthesia and postoperative pain control following orthopedic surgery.

The management of acute pain following proximal femoral fracture surgery presents a significant challenge due to its intensity and impact on patient recovery and complication rates. Traditional methods, such as intrathecal Morphine, while effective in reducing pain, often introduce a range of undesirable adverse effects like urinary retention, nausea, vomiting, itching, and a risk of respiratory depression, particularly concerning in elderly patients with comorbidities. This clinical trial investigated the comparative analgesic efficacy and safety profile of ultrasound-guided fascia iliaca compartment block (FICB) versus intrathecal Morphine in 60 patients undergoing proximal femoral surgery. The intervention group received FICB using 0.25% Levobupivacaine above the inguinal ligament, while pain levels were assessed using the VAS score, alongside monitoring of adverse effects, rescue Morphine consumption, and patient satisfaction over 24 postoperative hours. Results demonstrated that FICB provided superior effective analgesia, with mean resting and movement VAS scores consistently below 4 at all time points. Patients in the FICB group required significantly less rescue Morphine and reported substantially higher satisfaction (63.3% satisfied or very satisfied) compared to the intrathecal Morphine group (30%). Crucially, the FICB method was associated with a markedly lower incidence of adverse effects such as urinary retention (53.3% in Morphine group vs 0% in FICB group) and nausea/vomiting (23.3% in Morphine group vs 0% in FICB group), with no reported complications of local anesthetic toxicity, infection, or hemodynamic instability in the FICB group. This study concludes that ultrasound-guided fascia iliaca compartment block is an effective and safe alternative for postoperative analgesia after femoral neck fracture surgery, offering enhanced patient satisfaction and reduced adverse effects compared to intrathecal Morphine. These findings support its integration into multimodal pain management protocols, particularly for vulnerable patient populations.