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Abstract Traumatic femoral fractures often lead to substantial postoperative pain, a common trigger for emergence agitation in pediatric patients. Various analgesic approaches, including lumbar plexus nerve block, femoral nerve block, Fascia iliaca compartment block, spinal anesthesia, and epidural anesthesia, have been suggested for managing pain associated with lower limb surgery. The efficacy of femoral nerve block (FNB) in adults and children with femoral shaft fractures is extensively documented, offering a means to decrease reliance on intravenous opioids and enabling pain-free transportation, examination, and application of casts or splints. As peripheral nerve block techniques advance, the fascia iliaca compartment block (FICB) has become increasingly utilized for postoperative pain relief in hip, femoral bone, and knee surgeries. This method, known for its simplicity, cost-effectiveness, and efficacy, serves as a valuable analgesic approach for femoral fractures Aim of work: This study aimed to evaluate the analgesic effects of femoral nerve block vs fascia iliaca compartment block in traumatic femur fracture repair in the pediatric population. To elucidate this aim, 3 equal parallel groups were randomly assigned to either: Control group, Fascia Iliaca compartment block group, and femoral nerve block group. Each contains 30 patients. Summary 69 The main results: In the current study, there was no statistically significant difference between the three studied groups regarding age, sex, and weight. There was no statistical difference between the FNB group and the FICB group regarding intraoperative HR at 5,20,45,60.75,90 minute time intervals. There was a statistical difference between the FNB group, control group, and FICB group regarding post-operative HR at 30min, 60min, 90min, and 2hrs.4hrs, 6hrs minutes time interval. There was a statistical difference between the FNB group, control group, and FICB group regarding intra-operative MAP at 5,20,45,60.75,90 45-minute intervals. There was a statistical difference between the FICB group, FNB, and control group regarding post-operative MAP at 30min, 60min, 90min, and 2hrs.4hrs, 6hrs minutes time interval. As regards anesthetic consumption intraoperative fentanyl consumption was significantly lower in the FICB group than FNB group and in the control group. As regards post-operative 24hrs pethidine dose was statistically significantly lower in both the FICB group and FNB group than the control group. Post-operative 24hrs pethidine dose was lower in the FICB group than the FNB group but not statistically significant. As regards first-call rescue analgesia was statistically significantly higher in both the FICB group and FNB group than the control group. Summary 70 First-call rescue analgesia was higher in the FICB group than the FNB group but not statistically significant. There was no statistically significant difference between the three studied groups regarding postoperative complications. There was a statistical difference between the FICB group, FNB, and control group regarding post-operative FLACC at 30min, 60min, 90min, 2hrs.4hrs, 6hrs minutes time interval. Conclusion o FICB provides better postoperative pain control compared with FNB following traumatic femur fracture in the pediatric population. o However FICB had less nausea, bradycardia, hypotension, and hematoma but there was a non-significant difference between it and FNB. o FICB is also a simple, effective, and noninvasive analgesia for postoperative pain of femur fractures. FICB is better than FNB in the duration of anesthesia and block and pain scores. o FNB analgesia also is an easy and safe technique and improves pain in postoperative femur fracture. Recommendation: o Use of FICB as a regional anesthetic technique alternative to FNB in pediatrics undergoing femoral fracture repair surgeries as it provides better post-operative pain control with a wider range of sensory blocks in the lower limb, and less post-operative opioid use. Summary 71 o It is now important to move forward into the area of prevention and to more aggressive treatments for high-risk groups in pediatric patients with traumatic femur fractures. o Further studies should be done with longer follow-up periods, larger sample sizes, and control groups. o Further investigations regarding times of injection, the use of and adjuvant agents, should be accomplished. o Further study to determine the optimal effects of this regional block on such patients by checking the success rate of FICB and or FNB. o FICB is better than FNB in control of postoperative pain in traumatic femur fracture repair in the pediatric population and pain score. Future perspectives In the future, research endeavors should focus on comprehensive analyses to discern intra-institutional and regional practice trends, alongside extensive retrospective and prospective studies on pediatric cohorts undergoing treatment for femur fractures. Such investigations would contribute significantly to advancing our understanding of optimal management strategies in this population. |