Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur

Abstract

PurposeFracture of femur is a painful bone injury, worsened by any movement. This prospective study was performed to compare the analgesic effects of femoral nerve block (FNB) with intravenous (IV) fentanyl prior to positioning patients with fractured femur for spinal block.Patients and methodsSixty-four ASA I–III patients aged 18–80 years undergoing surgery for femur fracture were randomized into two groups. Fifteen minutes before spinal block, the FNB group received nerve stimulator-assisted FNB with a mixture of 20 mL bupivacaine 0.5% and 10 mL normal saline 0.9%, and the fentanyl group received two doses of IV fentanyl 0.5 μg/kg with a five-minute interval between doses. Numeric rating pain scores were compared. During positioning, fentanyl in 0.5 μg/kg increments was given every five minutes until pain scores were ≤4.ResultsThere were no statistically significant differences between the groups according to pain scores, need for additional fentanyl, and satisfaction with positioning before spinal block.ConclusionWe were unable to demonstrate a benefit of FNB over IV fentanyl for patient positioning before spinal block. However, FNB can provide postoperative pain relief, whereas side effects of fentanyl must be considered, and analgesic dosing should be titrated based on pain scores. A multimodal approach (FNB + IV fentanyl) may be a possible option.

Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

“…Full-text articles were excluded with no comparison (n = 4), no comparison of interest (n = 6), different interventions (n = 9), no relevant outcome measure (n = 12), and review articles (n = 4). Ten studies [10][11][12][13][14][15][16][17][18][19] were ultimately included for qualitative and quantitative synthesis. single centers in Italy [16], Ireland [18], Pakistan [10], India [12,13,15,17,19], Nepal [14], and Thailand [11].…”

“…Two [10,12] of the studies recruited a majority of females for FNB. Four [11,15,17,19] studies recruited equal numbers of the two sexes, and one [13] study provided no information on sex. Three trials [10,11,16] reported the time from trauma to surgery, and averages ranged from 2.3-15.6 days.…”

“…Increasing numbers of published studies compared FNB to IVA with femur fractures for positioning for SA [10][11][12][13][14][15][16][17][18][19]. But this evidence is not well-integrated.…”

“…Tables 1 and S2 show the characteristics of the included studies. Eight studies [10][11][12][14][15][16][17][18] were RCTs, and two studies [13,19] observational studies. These studies were performed in Positioning of femur fracture patients for spinal block PLOS ONE | https://doi.…”

Positioning for regional anesthesia in femur fracture surgeries: how effective is femoral nerve block? a randomised control study

“…There is sufficient data to show the usefulness of FNB to relieve pain from fracture of the femur and now, is being used for positioning during central neuraxial blockade as well. 3,4,12,[19][20][21][22] Femoral nerve block can be performed using peripheral nerve stimulator, ultrasound guided technique or by loss of resistance technique. Geier KO concluded that there were no significant differences regarding efficiency between loss of resistance and peripheral nerve stimulator methods.…”