Ultrasound‐guided femoral nerve block and intravenous fentanyl in pain management of the patients with hip fracture: a prospective, randomized, single blinded clinical trial

Abstract

Aim Proximal femoral fracture is a painful condition. Pain alleviation is a treatment cornerstone to both comfort the patient and reduce adverse effects. This study aimed to evaluate and compare ultrasound‐guided femoral nerve block and intravenous fentanyl administration in relieving the pain of patients with hip fractures. Methods The present interventional clinical trial was conducted on 40 patients referred to Shahid‐Bahonar Hospital with unilateral isolated proximal femur fracture and American Society of Anesthesiologists I and II. The patients were randomly divided into two groups: intravenous fentanyl and ultrasound‐guided femoral nerve block for pain management. Pain severity was assessed by a numerical rating scale before and after the intervention in both groups and the groups were then compared. Results Forty patients were enrolled in to study; 27 (67.5%) were male. There was no significant difference in demographic variables between the two groups. Fourteen (35%) were older than 80 years. Pain significantly decreased three scores compared to the pre‐intervention level in both groups (95% confidence interval, 2–4). This was slightly higher in the femoral nerve block group. The largest strength of association for age and numerical rating scale of pain was found in the differences between the pre‐intervention and after‐intervention in femoral nerve block group ( r = −0.775, P < 0.001). Conclusion We found similar pain severity between the two groups. Considering the possible side effects of fentanyl, an ultrasound‐guided femoral nerve block shows may provide safer pain control and may be particularly suitable for patients with opioid dependence.

Perioperative efficacy and safety of nerve blocks in elderly patients undergoing hip surgery:A single-centre randomized trial

“…Anna et al conducted a detailed postoperative follow-up on 236 elderly patients with hip fracture and found that compared with traditional drug analgesia, nerve block did not increase the incidence of adverse events in elderly hip surgery patients, which is consistent with our research results [21] . The conclusions in some other studies contradict our conclusion, and we think that this result is mainly caused by factors such as the study protocol, the method of anaesthesia, and the use of opioids [22,23,24] . During the period of this study, we did not observe any serious side effects in either patient group or side effects requiring withdrawal from this study.…”

Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomized trial

“…Although previous reviews have already supported the use of ultrasound-guided preoperative nerve blocks, suggesting reduced pain, less need for opioids and a reduced risk of adverse events compared to systemic analgesia, there was no trial considered to have low risk of bias [24,25,35]. Above all, few have examined the effects of a single ultrasound-guided FNB when performed by an emergency physician [18,[26][27][28][29]. The 60% opioid reduction in the first 48h of care is similar to that of a trial evaluating the 24-hours effects of FNB performed blindly (i.e.…”

“…through anatomical landmarks), while using it in adjunct to intravenous morphine [29]. Other trials may have been biased by the absence of randomization [18] or standardized rescue analgesia [28,29], or did not assess opioid consumption [26,27].…”

“…The level of evidence is low, however, due to the few randomized trials conducted, the high degree of statistical heterogeneity, and some degree of clinical heterogeneity both in the timing of implementation of ultrasound-guided FNB and in the assessment of its effects [24,25]. Finally, randomized trials focused on very short-term pain control (up to 3 h after the procedure) [26,27] or lacked standardized rescue analgesia [28,29].…”