Effectiveness of Ultrasound-guided Single-injection Triple Nerve Block Before Cementless Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures

Abstract

Purpose: To compare efficacy of ultrasound (US)-guided single-injection nerve blocks (SINB) before bipolar hemiarthroplasty (BHA) of the hip in patients with femoral neck fractures. Materials and Methods: Clinical outcomes of 89 patients who underwent BHA between September 2016 and February 2018 were retrospectively compared. Eight patients were excluded according to exclusion criteria and the remaining patients were divided into two groups: patients who received SINB before surgery (Group I; n=40), and patients who did not (Group II; n=41). The femoral, obturator, and lateral femoral cutaneous nerves were each blocked separately under US guidance. Pain scores determined using the visual analogue scale (VAS) were recorded 6, 12, 24, and 48 hours postoperatively, and all use of analgesics were recorded separately for 72 hours after surgery. Duration of hospitalization, general complications, and local complications due to SINB were also compared among the groups. Results: Significant differences were observed between the two groups: I) VAS at 6 hours and at 12 hours after the operation, II) total amounts of analgesics used. VAS at 24 hours and at 48 hours were not significantly different between the two groups. General complications and duration of hospitalization were also not significantly different between the groups. Conclusion: US-guided lower limb nerve blocks provide excellent immediate postoperative pain relief and can be used as a safe, and effective method of pain control after BHA.

Peripheral nerve blocks for through-knee amputation in a patient on extracorporeal membrane oxygenation

“…Our report is similar to reports of previous authors where regional anaesthesia was able to be used as a safe and satisfactory alternative anaesthetic technique in a critically ill patient requiring lower limb amputation surgery 12 13. As the duration of the nerve blocks can last for 24 hours, their analgesic effect can reduce immediate postoperative pain, opioid consumption and their related side effects 14 15. This was seen in our case as well including other postoperative outcomes such as reduced 30-day mortality and morbidity.…”

“…This was seen in our case as well including other postoperative outcomes such as reduced 30-day mortality and morbidity. In case, the effects of the nerve blocks are needed for more than 24 hours, serial nerve block injections or continuous nerve blockade catheters can be considered 16…”

Effectiveness of ultrasound-guided dual nerve block in the below-knee amputation

“…Under US guidance, the femoral (3-in-1 block) [ 3 ] and sciatic nerve (posterior popliteal approach) [ 4 ] were each blocked using 7.5 and 8 ml respectively, of 0.75% ropivacaine mixed with 7.5, 8 ml of 1% lidocaine at a 1:1 ratio (Fig. 2 ) [ 7 ]. A sensory test including a pinprick test was done after performing the block to confirm a successful block.…”

Evaluating pain management and complications from peripheral nerve block and intravenous patient-controlled analgesia for geriatric patients following bipolar hemiarthroplasty for displaced femoral-neck fracture

“…[13][14][15] Peripheral nerve block (PNB) is the recommended multimodal pain management for patients undergoing BHA. [16][17][18][19][20] Pain management after hip-fracture surgery in geriatric patients not only results in diminished pain, but also in diminished complications that could be caused by pain. However, most studies of multimodal pain management only focused on patient-reported subjective outcomes (e.g., visual analog scale (VAS)).…”