Efficacy of adding Dexmedetomidine in Fascia Iliaca Compartment Block to provide analgesia for positioning femur fracture patients before spinal anesthesia

Background: fascia iliaca compartment block (FICB) has been used to provide analgesia and facilitate positioning for spinal anesthesia in fracture femur patients with the problem of delayed onset of action. Aim of the study was to assess effectiveness of dexmedetomidine as adjuvant to FICB with bupivacaine to facilitate positioning for spinal anesthesia in fracture femur patients with decrease time to sensory block as primary outcome. Methods: in this prospective double blinded randomized controlled study, 60 patients, ASA I-III, aged 50-70 years, underwent femur fracture surgeries under spinal anesthesia were included. Patients were randomly assigned into two equal groups according to drug injected in FICB; Control group received 40ml 0.25% bupivacaine, and Dexmedetomidine group received dexmedetomidine 80µg in 40ml 0.25% bupivacaine. Twenty minutes after FICB, spinal anesthesia was given. Time to sensory block, fentanyl requirements, and pain during positioning were compared. Postoperative; time to first analgesic request, Pain score and total analgesic requirements were compared. Results: Time to sensory block was significantly shorter and pain during positioning for spinal anesthesia was significantly lower in Dexmedetomidine group, but there were no differences regarding fentanyl requirements. Postoperatively, Pain score was significantly lower after 6 and 8 hours in Dexmedetomidine group, time to first analgesic request was longer, and total analgesic requirements was less in Dexmedetomidine group. Conclusion: Addition of dexmedetomidine to bupivacaine in FICB is effective in enhancing onset and decreasing severity of pain during positioning for spinal anesthesia in fracture femur patients, with added postoperative analgesic effect.