An integrative comparative study between ultrasound-guided regional anesthesia versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: A systematic review and meta-analysis

Zaki, Hany A; Iftikhar, Haris; Shallik, Nabil A.; Elmoheen, Amr; Bashir, Khalid; Shaban, Eman; Azad, Aftab

doi:10.1016/j.heliyon.2022.e12413

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…The reasons for such a phenomenon remain poorly understood, but may include decreased physical activity, soil sealing, calcium and vitamin D deficiencies, less sun exposure, and changes in BMD (16)(17)(18).…”

Section: Regional DI Erences In Medical Servicesmentioning

confidence: 99%

Recent advances in the identification of related factors and preventive strategies of hip fracture

Wang

Hou

et al. 2023

Front. Public Health

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Hip fracture is the most devastating type of osteoporosis-related fracture, and is a major worldwide public health problem with a high socioeconomic burden, morbidity rate, and mortality rate. Thus, it is crucial to uncover the risk factors and protective factors to create a hip fracture prevention strategy. In addition to a briefly review of some well accepted risk and protective factors of hip fracture, this review mainly summarized the recent advances in the identification of emerging risk or protective factors for hip fracture, in terms of regional differences in medical services, diseases, drugs, mechanical load, neuromuscular mass, genes, blood types, cultural differences. This review provides a comprehensive review of the associated factors and effective prevention measures for hip fracture, and discusses issues that need further investigation. These issues include the determination of the influencing mechanism of risk factors triggering hip fracture and their interlinked correlation with other factors, as well as the confirmation or correction of emerging factors associated with hip fracture, particularly those that are still controversial. These recent findings will aid in optimizing the strategy for preventing hip fracture.

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Section: Regional DI Erences In Medical Servicesmentioning

confidence: 99%

Recent advances in the identification of related factors and preventive strategies of hip fracture

Wang

Hou

et al. 2023

Front. Public Health

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“…Although previous reviews have already supported the use of ultrasound-guided preoperative nerve blocks, suggesting reduced pain, less need for opioids and a reduced risk of adverse events compared to systemic analgesia, there was no trial considered to have low risk of bias [24,25,35]. Above all, few have examined the effects of a single ultrasound-guided FNB when performed by an emergency physician [18,[26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

“…Observational studies suggested that ultrasound-guided FNB was a promising strategy for decreasing pain during the many hours spent in the ED [18,[21][22][23][24]. The level of evidence is low, however, due to the few randomized trials conducted, the high degree of statistical heterogeneity, and some degree of clinical heterogeneity both in the timing of implementation of ultrasound-guided FNB and in the assessment of its effects [24,25]. Finally, randomized trials focused on very short-term pain control (up to 3 h after the procedure) [26,27] or lacked standardized rescue analgesia [28,29].…”

Section: Introductionmentioning

confidence: 99%

Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomized trial

Gerlier,

Mijahed,

Fels

et al. 2023

European Journal of Emergency Medicine

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Background and importance Ultrasound-guided femoral nerve block (FNB) could be used as part of a multimodal preoperative pain management for patients with hip fracture. Evidence of the effects of its early implementation in the emergency room as an immediate alternative to intravenous morphine titration is sparse. Objective To investigate the effect of an early ultrasound-guided FNB performed by emergency physicians on preoperative opioid consumption, compared to standard pain management. Design, setting, and participants This open randomized controlled trial was conducted in the Emergency Department of a French hospital with patients with neck or trochanteric femoral fracture who had a pain score ≥7 out of 10 points at triage. Intervention Patients were randomized to receive an initial analgesia with an early ultrasound-guided FNB or with standard pain management. The continuation of pain treatment followed standardized pain control guidelines until hospital discharge in both groups. Outcome measure and analysis The primary outcome was preoperative opioid consumption truncated 48h after triage time, and converted in morphine milligram intravenous equivalents (MME). Secondary outcomes were time to pain relief, time for regaining walk, opioid consumption and occurrence of opioid and FNB adverse effects during the hospital stay. Exploratory outcomes included ease and duration of the procedure. Main results We randomized 35 patients: 17 to standard pain management and 18 to ultrasound-guided FNB, among whom 30 patients completed the protocol. The median of preoperative opioid consumption was reduced by 60% in the ultrasound-guided FNB group compared to standard group [6 MME (3–9) vs. 15 MME (11–18)], with a consumption difference of 9 MME (95% CI: 3–14, P < 0.001). Throughout hospital stay, opioid consumption was reduced by 56% in the ultrasound-guided FNB group compared to standard group, with a consumption difference of 11.5 MME (95% CI: 0.5–22).Times to pain relief and for regaining walk did not differ between groups. Opioid adverse events occurrence were reduced by 40% (95% CI: 5.1–74.9) in the ultrasound-guided FNB group compared to standard group. No adverse effects of FNB have been detected. Conclusion Early ultrasound-guided FNB resulted in reducing preoperative opioid consumption, without delaying time to pain relief.

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“…However, there is evidence that TEA may provide more pain relief for rib fractures than intercostal blocks [ 34 ]. Furthermore, regional anesthesia seems more effective than parenteral opioids in patients with other injuries, such as hip fractures [ 35 ].…”

Section: Reviewmentioning

confidence: 99%

Comparative Analysis of Intravenous Opioids Versus Thoracic Epidural Anesthesia in Fractured Rib Pain Management: A Systematic Review and Meta-Analysis

Mohamed,

Elmoheen,

Bashir

et al. 2024

Cureus

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Rib fractures, common among trauma victims, lead to significant morbidity and mortality. Managing the associated pain is challenging, with IV opioids and thoracic epidural analgesia (TEA) being utilized. While epidural analgesia is often preferred for fractured rib pain, existing data encompasses both lumbar and thoracic approaches. This review aimed to compare TEA and IV opioids for persistent rib fracture pain. A comprehensive search across five databases yielded 987 articles, of which seven met the eligibility criteria. Outcomes were categorized into primary (pain reduction) and secondary (mortality, hospital/ICU stays, analgesia-related complications) endpoints. Analyzed with Review Manager (RevMan) Version 5.4.1 (2020; The Cochrane Collaboration, London, United Kingdom), the pooled data from two sources showed TEA significantly more effective in reducing pain than IV opioids (standardized mean difference ( SMD): 2.23; 95%CI: 1.65-2.82; p < 0.00001). Similarly, TEA was associated with shorter ICU stays (SMD: 0.73; 95%CI: 0.33-1.13; p = 0.0004), while hospitalization duration showed no substantial difference (SMD: 0.82; 95%CI: -0.34-1.98). Mortality rates also did not significantly differ between TEA and IV opioids (risk ratio (RR): 1.20; 95%CI: 0.36-4.01; p = 0.77). Subgroup analysis revealed fewer pneumonia cases with TEA (RR: 2.06; 95%CI: 1.07-3.96; P = 0.03), with no notable disparities in other complications. While TEA's superiority in pain relief for rib fractures suggests it is the preferred analgesic, the recommendation's strength is tempered by the low methodological quality of supporting articles.

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An integrative comparative study between ultrasound-guided regional anesthesia versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: A systematic review and meta-analysis

Cited by 6 publications

References 31 publications

Recent advances in the identification of related factors and preventive strategies of hip fracture

Recent advances in the identification of related factors and preventive strategies of hip fracture

Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomized trial

Comparative Analysis of Intravenous Opioids Versus Thoracic Epidural Anesthesia in Fractured Rib Pain Management: A Systematic Review and Meta-Analysis

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