Effects of Adjuvant in Potentiating the Analgesic Effect of Fascia Iliaca Compartment Block

Objective: Nerve blocks for postoperative analgesia have increased significantly lately. Beside the use of adjuvants plus local anesthetics in nerve block in order to extend the analgesia time. Materials and Methods: Sixty elderly patients, ASA grades II and III scheduled for surgery after hip fracture under intrathecal anesthesia with pre-operative FICB, The patients were blindly randomly allocated into three-study groups, all of them received preoperative FICB “bupivacaine 0.25 % with adjuvant either Group K received ketamine (50 mg), Group D received Dexmedetomidine (100 μg) and Group KD received ketamine (50 mg) Dexmedetomidine (100 μg) plus intrathecal block. Results: Group “KD” showed more satisfactory during positions to receive intrathecal block in compare with either groups due to significant rapid onset of preoperative analgesia in compared with other groups, group KD show significant rapid onset of sensory and motor block, prolonged duration of sensory block, and postoperative analgesia as compare with both group with significant decrease in total analgesic requirement. While group D provided significant prolonged duration of sensory block, and postoperative analgesia when compare with group K with significant decrease in total analgesic requirement. There were no significant differences between the three groups, hemodynamic change (heart rate and blood pressure) and side effects in form of baradycardia, hypotension, nausea, vomiting and sedation. Conclusion: The addition of ketamine, dexmedetomidine with bupivacaine 25% in FICB, is considered the best combination for intrathecal anesthesia for hip repair surgery in elderly patients. It provided intraoperative hemodynamic stability, prolonged motor and sensory block as well as potentiating the postoperative analgesic effect with minimal complications.