Pre‐operative femoral nerve block vs fascia iliaca block for femoral neck fracture – 6

Hewson, David W.; Reddy, R.

doi:10.1111/anae.12498

Cited by 3 publications

(5 citation statements)

References 3 publications

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“…Newman et al conducted a randomised controlled trial comparing analgesic efficacy of the FIB and the FNB for hip fracture patients . Although they reported greater efficacy for FNBs, there has been criticism of the trial methodology and the techniques of block delivery (see related comments . In addition, this trial did not use ultrasound guidance, therefore, all three nerves may not have been blocked correctly, and the trial did not include patients with cognitive impairment, which may have resulted in an underestimation of the effect of the block on delirium.…”

Section: Methodsmentioning

confidence: 99%

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

et al. 2017

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Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly. There is consistent evidence that regional nerve blocks can effectively reduce pain associated with hip fracture, providing rapid-onset, site-specific analgesia that is more effective than standard systemic analgesia alone. There is also moderate evidence that nerve blocks may contribute to reduced rates of delirium, and some suggestion of reduced length of inpatient stay, morbidity and mortality, although limited evidence is available. Fascia iliaca blocks are emerging as a block of choice, with evidence they can be safely and rapidly administered under ultrasound guidance in the acute setting, by both trained medical and nursing staff, with good effect. Ideally, comprehensive pain protocols for elderly hip fracture patients are required, that integrate evidence-based fascia iliaca block use, timely and repeated pain assessment, and multidisciplinary orthogeriatric patient care.

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Section: Methodsmentioning

confidence: 99%

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

et al. 2017

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“…An FICB is a volume-dependent block requiring 30-40 mL of local anesthetic in order to spread sufficiently through the sub-fascial compartment. 16 However, 10 to 20 mL of local anesthetic is usually sufficient to block the femoral nerve during FNB. Taha and colleagues concluded that perineural injection of 15 mL of ropivacaine 0.167% w/v under ultrasound guidance can achieve successful FNB in 90% of patients.…”

Section: Discussionmentioning

confidence: 99%

<p>A Randomized Controlled Trial of FNB versus FICB for Patients with Femoral Neck Fractures Before Spinal Anesthesia</p>

Liang¹,

Lv²,

He³

et al. 2020

CIA

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Background and Objectives: Patients with femoral neck fractures often suffer severe pain. This randomized controlled clinical study compared the effect of femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in this population. Patients and Methods: Forty-six patients were randomly assigned to one of the two groups: FNB group (femoral nerve block, n=23) or FICB group (fascia iliaca compartment block, n=23). Before positioning for spinal anesthesia, patients received FNB with 15 mL of 0.5% ropivacaine or FICB with 40 mL of 0.5% ropivacaine. Pain was evaluated using a visual analogue scale (VAS) at rest and during hip flexion after admission to the operation room; at 3, 5, 8, and 10 min after analgesia intervention; and during positioning for spinal anesthesia. Positioning was attempted after 10 min of analgesia intervention in each group. Time required to perform spinal anesthesia, quality of positioning, and patient satisfaction were documented. Results: The VAS scores in the FNB group were significantly lower than those in FICB group at 3 and 5 min after analgesia intervention (P=0.000). However, there were no significant differences in VAS between groups at 8 or 10 min or during positioning. Conclusion: FNB and FICB produce similar analgesic effects in patients with femoral neck fractures, but FNB has a more rapid onset of pain relief.

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“…As pointed out in our discussion, the pharmacokinetics of opioids are very unpredictable in the elderly, and we witnessed many cases of opioid toxicity requiring treatment before the development of our nerve block service. We would therefore dispute the statement that in these patients, "analgesia is best achieved using paracetamol and opioids in the first instance" [6].…”

mentioning

confidence: 97%

“…On behalf of my co-authors, I should like to thank all the correspondents for their comments [1][2][3][4][5][6][7][8][9] in response to our paper that compared pre-operative fascia iliaca and femoral nerve block in patients with a femoral neck fracture [10], and will attempt to respond to all the issues raised. Several correspondents have noted that the doses and dilutions used for both nerve stimulatorguided femoral nerve and fascia iliaca compartment blocks were the same, whereas it is customary to perform compartment blocks with a larger volume of more dilute drug.…”

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confidence: 99%

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Pre‐operative femoral nerve block vs fascia iliaca block for femoral neck fracture – a reply

Newman

2013

Anaesthesia

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Pre‐operative femoral nerve block vs fascia iliaca block for femoral neck fracture – 6

Cited by 3 publications

References 3 publications

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

<p>A Randomized Controlled Trial of FNB versus FICB for Patients with Femoral Neck Fractures Before Spinal Anesthesia</p>

Pre‐operative femoral nerve block vs fascia iliaca block for femoral neck fracture – a reply

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