Efficacy of Ultrasound-Guided Caudal Epidural Block for Postoperative Analgesia in Patients Undergoing Femur Fracture Surgery under Subarachnoid Block

Background: Femur fracture surgery is commonly associated with significant postoperative pain, which may delay mobilisation and recovery. Although subarachnoid block provides effective intraoperative anaesthesia, its postoperative analgesic duration is limited. Ultrasound-guided caudal epidural block may provide extended analgesia and reduce systemic analgesic requirement. Material and Methods: This hospital-based, prospective, randomized controlled study included 70 patients undergoing femur fracture surgery under subarachnoid block. Patients were randomly allocated into two groups of 35 each. Group A received ultrasound-guided caudal epidural block with 0.2% ropivacaine at 0.3 ml/kg, while Group B received conventional intravenous analgesia. Postoperative pain was assessed using the Visual Analogue Scale at 2-hour intervals for 24 hours. Time to first rescue analgesia, total tramadol consumption, and complications were recorded. Results: Baseline demographic and operative characteristics were comparable between groups. VAS scores were consistently lower in the caudal block group throughout the 24-hour postoperative period. Time to first rescue analgesia was longer and total tramadol consumption was lower in Group A, although differences were not statistically significant. Complications were comparable between groups. Conclusion: Ultrasound-guided caudal epidural block is a safe and feasible adjunct for postoperative analgesia after femur fracture surgery, with a favourable trend toward better pain control and reduced opioid requirement.

Keywords: caudal epidural block, femur fracture, postoperative analgesia, ropivacaine, subarachnoid block, ultrasound guidance.