Aim : The aim of this study was to compare analgesic efficacy of three–in–one nerve block (TINB) and fascia iliac compartment block (FICB) to facilitate positioning of patients with hip fracture for spinal anesthesia.

Material and Methods:  Sixty adult patients undergoing surgery for hip fracture were randomly allocated to receive either TINB (n=30) or FICB (n=30) using 0.5% ropivacaine under ultrasound guidance. Sensory blockade, VAS score, and hemodynamic monitoring were carried out at 5 minute interval till 20 minutes after the block. Quality of patient positioning and VAS score was noted when the patients were made to sit for spinal anesthesia.

Results :Sensory blockade in lateral compartment of thigh was present in 18 patients in FICB group and 4 patients in TINB group after 10 minutes of nerve block (p<0.001). Sensory blockade was present in 23 patients in FICB group and in 15 patients in TINB group after 20 minutes of nerve block (p=0.02). Complete sensory blockade after 20 minutes of nerve blockwas present in 22 patients in FICB group and in 14 patients in TINB group(p=0.02). Twenty minutes after the block, VAS decreased from baseline value of 7.70±1.37(mean±SD) to 4.33±1.40(mean±SD) in FICB group  and from baseline value of 7.73±1.48(mean±SD)  to 4.40 ±0.81(mean±SD) in TINB group.

Conclusion: FICB is a better analgesic technique as compared to TINB to facilitate sitting position for spinal anesthesia in patients undergoing surgery for hip fracture because sensory blockade of lateral femoral cutaneous nerve is achieved better in FICB as compared to TINB.

Clinical significance: Positioning of the patients with hip fracture for spinal anesthesia is very difficult as even minimal movements of fracture ends are extremely painful; FICB is an effective technique for pain relief during positioning for spinal anesthesia.