Femoral nerve block for acute pain relief in fracture shaft femur in an emergency ward

Somvanshi, Mukesh; Tripathi, Archana; Meena, Naval

doi:10.4103/1658-354x.159471

Cited by 14 publications

(9 citation statements)

References 6 publications

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“…Application of these results to patients with femoral shaft and distal fractures should be done with caution. Somvanshi et al [15] also reported that pain scores significantly decreased, but the quality of analgesia did not change when patients underwent a radiological examination and traction application after femoral nerve block in patients with fracture of the femur shaft in the emergency ward.…”

Section: Discussionmentioning

confidence: 99%

Fascia iliaca compartment block versus intravenous analgesic for positioning of femur fracture patients before a spinal block

Hsu

Bai³

et al. 2018

Medicine

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Background:Fascia iliaca compartment block (FICB) provides an analgesic option for positioning before spinal anesthesia in patients suffering from a femur fracture. The evidence supporting FICB is still not well established. The aim of our study is to assess the efficacy and safety of FICB comparing with intravenous analgesic (IVA) on the quality for positioning before spinal anesthesia in participants with a femur fracture.Methods:PubMed, Embase, and Scopus databases were interrogated from their inceptions to September 2017. We included randomized controlled studies reported as full text, those published as abstracts only and unpublished data, if available. Data were independently extracted by 2 reviewers and synthesized using a random-effects model.Main Results:Three studies comprising 141 participants showed that FICB compared to IVA led to a significant between-group standard mean differences in quality during positioning within 30 minutes before spinal anesthesia (standardized mean difference (SMD) −2.02, 95% confidence interval (CI): −2.43 to −1.61, I2 = 0%) and time for spinal anesthesia (pooled mean difference (PMD) −2.86 minutes, 95% CI −3.70 to −2.01, I2 = 0%). Two studies with 101 participants suggested that FICB is superior to IVA on opioid requirements 24 hours postoperatively (pooled odds ratio (POR): 0.11, 95% CI: 0.03 to 0.35, I2 = 13%). There were no significant differences in complications or hemodynamic effectsConclusions:Comparing with IVA, FICB can provide significantly better quality during positioning of femur fracture patients for a spinal block and a shorter time for spinal anesthesia. FICB is safe method.

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Section: Discussionmentioning

confidence: 99%

Fascia iliaca compartment block versus intravenous analgesic for positioning of femur fracture patients before a spinal block

Hsu

Bai³

et al. 2018

Medicine

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“…In the non-surgical adult population, using a prospective, randomized, but non-blinded study protocol, regional anesthetic techniques (3-in-1 block or FNB) have been shown to decrease morphine requirements and lower pain scores when compared to use of opioids alone. 13 – 15 In a non-blinded, prospective, randomized study in a non-surgical population, Wathen et al reported lower pain scores in pediatric patients with a femur fracture who received a fascia iliaca compartment nerve block in the ED when compared to intravenous morphine. 16 When comparing the entire 6-h study period pain scores, pain scores were approximately 15% lower in patients who received a fascia iliaca compartment nerve block.…”

Section: Discussionmentioning

confidence: 99%

A prospective, double-blinded, randomized comparison of ultrasound-guided femoral nerve block with lateral femoral cutaneous nerve block versus standard anesthetic management for pain control during and after traumatic femur fracture repair in the pediatric population

Elsey¹,

Tobias

Klingele

et al. 2017

JPR

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BackgroundTraumatic injury of the femur resulting in femoral fracture may result in significant postoperative pain. As with other causes of acute pain, regional anesthesia may offer a benefit over conventional therapy with intravenous opioids. This study prospectively assesses the effects of femoral nerve blockade with a lateral femoral cutaneous nerve block (FN-LFCN) on intraoperative anesthetic requirements, postoperative pain scores, and opioid requirements.Materials and methodsSeventeen pediatric patients (age 2–18 years) undergoing surgical repair of a traumatic femur fracture fulfilled the study criteria and were randomly assigned to general anesthesia with either an FN-LFCN block (n = 10) or intravenous opioids (n = 7). All patients received a general anesthetic with isoflurane for maintenance anesthesia during the surgical repair of the femur fracture. Patients randomized to the FN-LFCN block group received ultrasound-guided nerve blockade using ropivacaine (0.2%/0.5% based on patient weight). At the conclusion of surgery, the airway device was removed once tracheal extubation criteria were achieved, and patients were transported to the post-anesthesia care unit (PACU) for recovery and assessment of pain by a blinded study nurse.ResultsThe final study cohort included 17 patients (n = 10 for FN-LFCN block group; n = 7 for the intravenous opioid group). Although the median of the maximum postoperative pain scores in the regional group was 0, this did not reach statistical significance when compared to the median pain score of 3 in the intravenous opioid group. Likewise, no difference between the two groups was noted when comparing intraoperative anesthetic requirements, opioid requirements (intraoperative, in the post-anesthesia recovery room, and in the inpatient ward), and the time to first opioid requirement postoperatively in the inpatient ward.ConclusionThis prospective, randomized, double-blinded study failed to demonstrate a clear benefit of regional anesthesia over intravenous opioids intraoperatively and postoperatively during repair of femoral shaft fractures in the pediatric population.

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“…preoperative baseline VAS scores as observed in our study and described in other studies. 1,4 Paracetamol, ketamine, non-steroidal anti-inflammatory drugs, or opioids have been used to relieve pain during positioning, but have their limitations. 2,3 The femoral nerve block, a simple and easy to perform procedure, has been used both pre-emptively as well as post-operatively for fracture femur surgeries, anterior aspect of thigh or knee surgeries, or for physiotherapy after knee surgery.…”

Section: Group Us (N = 30)mentioning

confidence: 99%

“…Fracture femur pain is a painful condition that often gets intolerable on movement especially during shifting, positioning during regional anesthesia or radiological evaluation. 1 Various drugs are used for its management, such as nonsteroidal anti-inflammatory drugs or intravenous opioids, but, each has its limitations and side effects. Recently, femoral nerve block (FNB) which can be given either by using a nerve stimulator or under ultrasound guidance, has gained popularity.…”

Section: Introductionmentioning

confidence: 99%

Nerve Stimulator vs Ultrasound-guided Femoral Nerve Block for Ease of Positioning before Spinal Anesthesia in Fracture Femur Patients: A Randomized Comparative Study

Janagal¹,

Pushkarna²

2020

AMEI's Current Trends in Diagnosis &Amp; Treatment

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Introduction: Severe pain in the fractured femur makes it difficult to position a patient for spinal anesthesia. Femoral nerve block (FNB) has been studied for relief of pain, but studies are inconclusive regarding the superiority of one technique over another, i.e., nerve stimulation vs ultrasound for guidance. Aims and objectives: This study aims to compare the ease of positioning for spinal anesthesia in fracture femur cases using two different techniques of localization of femoral nerve for the block. Materials and methods: In this prospective, randomized, single-blind study, 60 patients of fracture femur were allocated in two equal groups of nerve stimulator (group NS) and ultrasound-guided (group US) femoral nerves block and compared regarding ease of positioning, duration of analgesia, and need for rescue doses of tramadol using SPSS version 26. Results: The patients in the two groups were similar in age, sex, weight, BMI, and initial pain severity (p = 0.920). The visual analog scale (VAS) scores within the groups were markedly reduced at 15 minutes in both the groups (p = 0.000) and between the two groups pain relief was more in group US than group NS at 5 and 10 minutes (p = 0.000 and p = 0.034, respectively), but, was comparable at 15 minutes (p = 0.310). The ease of positioning was observed in 27 patients in group US vs 20 patients NS (p = 0.028) as grade-I (comfortable), whereas grade II (discomfort) present in 3 vs 9 patients (p = 0.053), and grade III (uncomfortable) was seen only in one patient in group NS. The duration of analgesia in group US vs NS was 464.0 ± 170.61 and 282.9 ± 126.85 minutes, respectively (p = 0.003) and lesser need for rescue dose of tramadol (134.20 ± 23.20 vs 174.43.83 ± 47.74 mg) (p = 0.002). The vascular puncture was the main complication observed in group NS. Conclusion: Both the techniques of FNB provided adequate analgesia for fracture femur pain, but the ultrasound technique provided earlyonset, better patient comfort, and longer duration of analgesia than the landmark nerves stimulation technique.

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Femoral nerve block for acute pain relief in fracture shaft femur in an emergency ward

Cited by 14 publications

References 6 publications

Fascia iliaca compartment block versus intravenous analgesic for positioning of femur fracture patients before a spinal block

Fascia iliaca compartment block versus intravenous analgesic for positioning of femur fracture patients before a spinal block

A prospective, double-blinded, randomized comparison of ultrasound-guided femoral nerve block with lateral femoral cutaneous nerve block versus standard anesthetic management for pain control during and after traumatic femur fracture repair in the pediatric population

Nerve Stimulator vs Ultrasound-guided Femoral Nerve Block for Ease of Positioning before Spinal Anesthesia in Fracture Femur Patients: A Randomized Comparative Study

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