Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial

Unneby, Anna; Svensson, Olle; Gustafson, Yngve; Olofsson, Birgitta

doi:10.1016/j.injury.2017.04.043

Cited by 53 publications

(75 citation statements)

References 34 publications

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“…We removed 575 duplicates from the initial pool of papers. After screening title and abstract, 12 papers were selected for full‐text review. Reasons for exclusion of full‐text articles were because they were either replies to editors (n = 1), used fascia iliaca compartment block in addition to FNB (n = 1), had no comparison with systemic analgesic (n = 1) or had a too short follow‐up time (n = 5) …”

Section: Resultsmentioning

confidence: 99%

Pre‐operative femoral nerve block for hip fracture—A systematic review with meta‐analysis

Skjold

Møller

Wildgaard

2019

Acta Anaesthesiol Scand

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Background: Pre-operative pain management of hip fracture patients is complex.Femoral nerve block (FNB) is used for hip fractures to reduce pain and demand for systematic analgesia. The objective of the study was to systematically investigate the efficacy of single-shot FNB for hip fracture patients. Methods:Five databases were searched from inception until 8 May 2019. We included randomized controlled trials (RCT's) assessing pain relief in patients with hip fractures. Intervention was pre-operative FNB compared to any systemic analgesic (eg opioids, non-steroidal anti-inflammatory drugs or paracetamol). Primary outcomes assessed were pre-operative pain and use of rescue analgesics. Secondary outcome was cognitive impairment. We present a bias assessment, a meta-analysis and a grading of certainty of evidence. Results:We included five trials (n = 254), where participants received FNB 30 minutes or more prior to surgery; all were judged as having high risk of bias. All studies found significantly decreased pain scores at least once in the intervention group compared to the control group. Meta-analysis on the primary outcome of pain showed significance. Mean difference was −2.13 point (in cm) (CI:-3.53,-0.72) on visual analogue scale in the intervention group, but is judged low on certainty. Conclusions:The quantity of evidence supporting pre-operative single-shot FNB for hip fractures is very low, and the certainty of evidence supporting pre-operative single-shot FNB for hip fractures is low. No studies using ultrasound guided technique were identified. Data on non-ultrasound guided FNB's suggest a decreased pain score compared to the use of systemic analgesia. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section.How to cite this article: Skjold C, Møller AM, Wildgaard K.Pre-operative femoral nerve block for hip fracture-A systematic review with meta-analysis.

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Section: Resultsmentioning

confidence: 99%

Pre‐operative femoral nerve block for hip fracture—A systematic review with meta‐analysis

Skjold

Møller

Wildgaard

2019

Acta Anaesthesiol Scand

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“…The presence of dementia is a significant issue in patients with hip fractures with 30–45% of this population having a diagnosis of dementia . Despite this, many randomised controlled trials investigating hip fractures have excluded patients with dementia and cognitive impairment …”

Section: Introductionmentioning

confidence: 99%

“…5,6 Despite this, many randomised controlled trials investigating hip fractures have excluded patients with dementia and cognitive impairment. 7,8 Typically, patients who present to hospital with a neck of femur or proximal femoral fracture are in a significant amount of pain. One of the essential aspects of the initial treatment of this patient group in the ED is delivering effective pain relief.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided femoral nerve blocks are not superior to ultrasound‐guided fascia iliaca blocks for fractured neck of femur

Cooper

Nagree

Goudie

et al. 2018

Emerg Medicine Australasia

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“…El examen detallado del bloqueo del nervio femorocutáneo lateral muestra cambios sensitivos que inician del trocánter mayor hacia abajo a la cara lateral del muslo. Por lo tanto, el efecto analgésico del bloqueo de fascia ilíaca y el bloqueo 3 en 1 puede estar más asociado con la relajación del músculo cuádriceps al bloquear el nervio femoral (6) . El bloqueo PENG cubre las tres ramas justo entre la espina iliaca anteroinferior (EIAI) y la EIP (Figura 1).…”

Section: Revista Mexicana Deunclassified

Bloqueo del grupo de nervios pericapsulares (PENG) para cirugía de cadera

Zaragoza-Lemus¹,

Portela-Ortiz²,

Díaz-Guevara³

2020

Revista Mexicana De Anestesiología

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RESUMEN. La anestesia regional se realiza cada vez más en pacientes con fractura de cadera; ofrece mejor analgesia y menor consumo de opioides con disminución de sus efectos secundarios. Se ha estudiado la inervación sensitiva de la articulación de la cadera y el mecanismo de acción de diferentes bloqueos nerviosos; lo que nos ha llevado a proponer el abordaje del bloqueo de las ramas de los nervios pericapsulares; lo cual bloquea únicamente las ramas articulares sensitivas en forma unilateral. Técnica: Con el paciente en decúbito dorsal, se coloca el transductor convexo en plano transverso sobre la espina Iliaca anteroinferior, posteriormente se alinea con la eminencia iliopectínea de la rama púbica, rotándolo 45º hacia medial. Se inserta una aguja en plano de 80 mm en dirección lateral a medial, se deposita el anestésico local en lo profundo del tendón del psoas. Discusión: La identificación de la sonoanatomía es fundamental en el bloqueo PENG, no es un bloqueo avanzado, pero el anestesiólogo podría tener un bloqueo no exitoso y perder todos los beneficios de esta técnica. Por lo cual, presentamos las imágenes en forma detallada del procedimiento. ABSTRACT. Regional anesthesia is increasingly being performed in patients with hip fracture, offering better analgesia and lower consumption of opioids reducing their side effects. Recently, the sensitive innervation of the hip joint and the mechanism of action of different nerve blocks have been studied. This has led us to develop a novel ultrasound-guided approach for blockade of articular branches of the hip nerves, pericapsular nerve group. Which blocks only the sensory articular branches unilaterally. Technique: with the patient in the dorsal position, the transverse convex transducer is placed on the anterior inferior iliac spine, then align with the Iliopectineal eminence of the pubic branch rotating it 45º counter clockwise. An 80 mm flat needle is inserted lateral to medial and the local anesthetic is deposited deep in the psoas tendon. Discussion: The identification of sonoanatomy is fundamental in the PENG block, it is not an advanced block, but the anesthesiologist could have an unsuccessful block and lose all the benefits of this technique. Therefore, we present the images in detail of the procedure. Palabras clave:Bloqueo PENG, cirugía de cadera, analgesia.

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Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial

Cited by 53 publications

References 34 publications

Pre‐operative femoral nerve block for hip fracture—A systematic review with meta‐analysis

Pre‐operative femoral nerve block for hip fracture—A systematic review with meta‐analysis

Ultrasound‐guided femoral nerve blocks are not superior to ultrasound‐guided fascia iliaca blocks for fractured neck of femur

Bloqueo del grupo de nervios pericapsulares (PENG) para cirugía de cadera

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