Femoral nerve block for fractured shaft of femur

Abstract

Twenty five adults and children with fractured shaft of femur were given femoral nerve block for pain relief. The block was found to be useful for purposes of transportation and immobilization. The pain relief was complete if the fracture site was in the middle third of the femoral shaft. The block is easy, safe, economical and most useful in emergency and poor risk patients.KEY WORDS: ANAESTHETIC TECHNIQUES, Regional, femoral nerve block;Fracture, Shaft of femur.Femoral nerve block for fractured shaft of femur has not received its due consideration, although the block provides quickest and most effective pain relief. 1 Patients with fractured shaft of femur present at the hospital in severe pain which arises from the periosteum, which is one of the very sensitive structures in the body. Little detail is available concerning the nerve supply of the periosteum covering the shaft of the femur. Last 2 refers in general to the periosteum of superficial bones deriving its supply from the nerves to the overlying skin, while in deeper parts the motor branches to nearby muscles provide the supply. It seems likely that the nerve supply to the periosteum of the femoral shaft is derived principally from the femoral nerve supplying the quadriceps femoris muscle, which has major attachments to the shaft of the bone. Pain causes spasm of the thigh muscles, leading to displacement of the broken bone ends and so to a vicious circle of more pain and consequent spasm. This produces a state of neurogenic shock which might aggravate any oligaemic shock from occult blood loss into the thigh at the fracture site.We studied the effectiveness of femoral nerve block in 25 patients with fractured shaft of femur admitted to our hospital, of whom 17 were male and 8 female. Can. Anaesth. Soc. J., vol. 29, no. 3, May 1982 emergencies who were unprepared or ill-prepared, and a few had associated injuries. Only eight were in-patients. No analegesic supplement was given to assure more accurate evaluation of the pain relief from the block alone. Blocks were carried out by Labat's technique as decribed by Moore, 3 using lidocaine hydrochloride one per cent with adrenaline I:180,000(W/V). Ten ml was used in adults. In children the amoum was limited to 5 ml. Lidocaine was preferred over other local anaesthetics because of quick onset of action and the greater success rate due to its high tissue penetrating power. Intensity of pain was assessed both subjectively and objectively, on movement of fracture site, rotation of and traction on the injured limb, before and after giving the nerve block.Seven nerve blocks were done for transportation of patients from the emergency surgical ward to the radiology department, eight for immobilization by splint with skin traction, and ten for reduction and application of a hip spica. The block was found to be most useful in almost all patients for transportation and immobilization by splint with traction. Results were considered fair for reduction and hip spica application, in that a few patients needed...

Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1) com ropivacaína e a analgesia subaracnóidea com morfina

“…Popularizou-se pela facilidade de administração, porém alguns estudos falham em demonstrar benefícios com a técnica, particularmente relacionados aos efeitos colaterais relativamente comuns como sedação, náuseas e prurido, especialmente com altas doses de morfina subaracnóidea 6,7 . O bloqueio do plexo lombar pela técnica 3 em 1 é proposto para analgesia pós-operatória de cirurgias de joelho 6,16,18,29,[37][38][39] , osteossíntese de fêmur 19 e cirurgias de quadril 24 , sendo rotina em alguns serviços 6 . Estudo com distribuição aleatória, examinando a infusão contínua de anestésico local no nervo femoral, demonstrou melhor analgesia, comparada ao uso sistêmico de opióides 6,39 .…”

“…A técnica clássica de Winnie, proposta para o bloqueio 3 em 1, utiliza 20 ml de anestésico. O presente estudo optou por volume maior visando diminuir a incidência de falhas, como sugerido por outros autores 19,20 . A falha observada no presente estudo foi semelhante a estudos prévios em que ocorreu de 7% a 20% 1, 41,45,46 .…”

“…It became popular for its easy administration, but some studies have failed in showing benefits with the technique, especially regarding the relatively common side-effects, such as sedation, nausea and pruritus, frequently seen with high spinal morphine doses 6,7 . Lumbar plexus block by the 3-in-1 technique is proposed for postoperative analgesia in knee 6,16,18,29,[37][38][39] , femur osteosynthesis 19 and hip surgeries 24 , being a routine in some hospitals 6 . A randomized study evaluating local anesthetics continuous infusion in the femoral nerve has shown better analgesia as compared to systemic opioids 6,39 .…”

“…It is easily performed, being indicated for knee [14][15][16][17][18] , femur 19,20 , hip 1, [21][22][23][24] and muscle biopsy 25 procedures. It has been reported that the 3-in-1 blockade provides satisfactory and prolonged analgesia with low incidence of side-effects, including hemodynamic changes, which are frequent in epidural or spinal anesthesia 21,22 .…”

“…A área de anestesia abrangida pelo bloqueio inclui a parte anterior, medial e lateral da coxa, face medial da perna, assim como o periósteo do fêmur e do joelho 1,10,13 . É facilmente realizado, sendo indicado para procedimentos no joelho [14][15][16][17][18] , fêmur 19,20 , quadril 1, [21][22][23][24] e biópsia muscular 25 . Tem sido relatado que o bloqueio 3 em 1 proporciona analgesia satisfatória, prolongada, com baixo índice de efeitos colaterais, incluindo alterações hemodinâmicas, freqüentemente potenciais à anestesia peridural ou subaracnóidea 21,22 .…”