Intrathecal Morphine,Femoral Nerve Block,Periarticular Bupivacaine Infiltration for Pain After Intramedullary Hip Screw

Intrathecal Morphine,Femoral Nerve Block,Periarticular Bupivacaine Infiltration for Pain After Intramedullary Hip Screw

Post Operative Pain Control Among Intrathecal 0.1 mg Morphine, Femoral Nerve Block, or Periarticular Infiltration of 20 mL of 0.25% Bupivacaine in Patients Post Intramedullary Hip Screw

Falls are a common problem in elderly patients resulting fractured femur, which require early operation. Adequate postoperative pain control will provide good recovery. The investigators will compare the efficacy of postoperative pain control among intrathecal morphine, femoral nerve block, and periarticular infiltration with bupivacaine in patients undergone intramedullary hip screw under spinal anesthesia.

Study methods : Every patients without any exclusion criteria will be performed spinal anesthesia by 0.5% heavy bupivacaine then divided into 4 groups Controlled group : spinal anesthesia alone Femoral nerve block by 20 mL of 0.25% bupivacaine before spinal anesthesia Spinal anesthesia plus 0.1 mg morphine intrathecally Spinal anesthesia plus periarticular infiltration with 20 mL of 0.25% bupivacaine All patients will receive postoperative intravenous patient controlled analgesia (IV PCA) morphine for 48 hours. Data collection Demographic data Pain score : preoperative, 3 hours postoperative in the 1st six hours, 12 hours postoperative by visual analog scoring system (VASS) Patient global assessment and patient satisfactory VASS at 24 and 48 hours postoperative The amount of morphine at 24 and 48 hours postoperative and the time of the 1st dose

1.8-2.5 mL of 0.5% heavy bupivacaine for spinal anesthesia 20 mL of 0.25% bupivacaine for femoral nerve block 0.1 mg of intrathecal morphine 20 mL of 0.25% bupivacaine for periarticular infiltration

Efficacy of pain control measured by The amout of morphine consumption Visual analogue pain scale Patient satisfaction by patient global assessment Incidences of adverse events : nausea, vomiting, pruritus

Inclusion Criteria: 18-90 years old good consciousness, well co-operated, can use PCA machine ASA class 1-3 no contraindication of spinal anesthesia accept for spinal anesthesia body weight > 30 kg BMI 20-35 kg/m2 no history of research-drug allergy Exclusion Criteria: previous history of hip surgery (the same side) pathological fractured such as severe infection, bone cancer

Guay J, Kopp S. Peripheral nerve blocks for hip fractures in adults. Cochrane Database Syst Rev. 2020 Nov 25;11(11):CD001159. doi: 10.1002/14651858.CD001159.pub3.