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Iacovazzo C, Sara R, Buonanno P, Vargas M, Coviello A, Punzo R, Maffei V, Marra A. The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study. Diagnostics (Basel) 2024; 14:827. [PMID: 38667473 PMCID: PMC11049482 DOI: 10.3390/diagnostics14080827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND An adequate early mobilization followed by an effective and pain-free rehabilitation are critical for clinical and functional recovery after hip and proximal femur fracture. A multimodal approach is always recommended so as to reduce the administered dose of analgesics, drug interactions, and possible side effects. Peripheral nerve blocks should always be considered in addition to spinal or general anesthesia to prolong postoperative analgesia. The pericapsular nerve group (PENG) block appears to be a less invasive and more effective analgesia technique compared to other methods. METHODS We conducted multicenter retrospective clinical research, including 98 patients with proximal femur fracture undergoing osteosynthesis surgery within 48 h of occurrence of the fracture. Thirty minutes before performing spinal anesthesia, 49 patients underwent a femoral nerve (FN) block plus a lateral femoral cutaneous nerve (LCFN) block, and the other 49 patients received a PENG block. A non-parametric Wilcoxon-Mann-Whitney (α = 0.05) test was performed to evaluate the difference in resting and dynamic numerical rating scale (NRS) at 30 min, 6 h, 12 h, and 24 h. RESULTS the PENG block administration was more effective in reducing pain intensity compared to the FN block in association with the LFCN block, as seen in the resting and dynamic NRS at thirty minutes and 12 h follow-up. CONCLUSION the PENG block was more effective in reducing pain intensity than the femoral nerve block associated with the lateral femoral cutaneous nerve block in patients with proximal femur fracture undergoing to osteosynthesis.
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Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Rosario Sara
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Roberta Punzo
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Vincenzo Maffei
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
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Gerlier C, Mijahed R, Fels A, Bekka S, Courseau R, Singh AL, Ganansia O, Chatellier G. Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomized trial. Eur J Emerg Med 2024; 31:18-28. [PMID: 37650732 DOI: 10.1097/mej.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND IMPORTANCE Ultrasound-guided femoral nerve block (FNB) could be used as part of a multimodal preoperative pain management for patients with hip fracture. Evidence of the effects of its early implementation in the emergency room as an immediate alternative to intravenous morphine titration is sparse. OBJECTIVE To investigate the effect of an early ultrasound-guided FNB performed by emergency physicians on preoperative opioid consumption, compared to standard pain management. DESIGN, SETTING, AND PARTICIPANTS This open randomized controlled trial was conducted in the Emergency Department of a French hospital with patients with neck or trochanteric femoral fracture who had a pain score ≥7 out of 10 points at triage. INTERVENTION Patients were randomized to receive an initial analgesia with an early ultrasound-guided FNB or with standard pain management. The continuation of pain treatment followed standardized pain control guidelines until hospital discharge in both groups. OUTCOME MEASURE AND ANALYSIS The primary outcome was preoperative opioid consumption truncated 48h after triage time, and converted in morphine milligram intravenous equivalents (MME). Secondary outcomes were time to pain relief, time for regaining walk, opioid consumption and occurrence of opioid and FNB adverse effects during the hospital stay. Exploratory outcomes included ease and duration of the procedure. MAIN RESULTS We randomized 35 patients: 17 to standard pain management and 18 to ultrasound-guided FNB, among whom 30 patients completed the protocol. The median of preoperative opioid consumption was reduced by 60% in the ultrasound-guided FNB group compared to standard group [6 MME (3-9) vs. 15 MME (11-18)], with a consumption difference of 9 MME (95% CI: 3-14, P < 0.001). Throughout hospital stay, opioid consumption was reduced by 56% in the ultrasound-guided FNB group compared to standard group, with a consumption difference of 11.5 MME (95% CI: 0.5-22).Times to pain relief and for regaining walk did not differ between groups. Opioid adverse events occurrence were reduced by 40% (95% CI: 5.1-74.9) in the ultrasound-guided FNB group compared to standard group. No adverse effects of FNB have been detected. CONCLUSION Early ultrasound-guided FNB resulted in reducing preoperative opioid consumption, without delaying time to pain relief.
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Affiliation(s)
| | - Rami Mijahed
- Emergency Department, Paris Saint-Joseph Hospital Group
| | - Audrey Fels
- Clinical Research Department, Paris Saint-Joseph Hospital Group
| | - Samir Bekka
- Anesthesiology Department, Paris Saint-Joseph Hospital Group
| | - Romain Courseau
- Orthopedic Surgery Department, Paris Saint-Joseph Hospital Group
| | | | | | - Gilles Chatellier
- Clinical Research Department, Paris Saint-Joseph Hospital Group, University Paris-Cité, Paris, France
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Tsai TY, Yeh HT, Liu YC, Lee CH, Chen KF, Chou E, Sun JT, Chen KC, Lee YK, Chau SW. Trends of Regional Anesthesia Studies in Emergency Medicine: An Observational Study of Published Articles. West J Emerg Med 2022; 23:878-885. [DOI: 10.5811/westjem.2022.8.57552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/27/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Regional anesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades. Nevertheless, there is a paucity of data on how RA practice has evolved in the specialty. In this study we sought to investigate how RA has been implemented in EM by analyzing trends of published articles and to describe the characteristics of the published research.
Methods: We retrieved RA-related publications from the SciVerse Scopus database from inception to January 13, 2022, focusing on studies associated with the use of RA in EM. The primary outcome was an analysis of trend based on the number of annual publications. Other outcomes included reports of technique diversity by year, trends in the use of individual techniques, and characteristics of published articles. We used linear regression analysis to analyze trends.
Results: In total, 133 eligible publications were included. We found that overall 23 techniques have been described and results published in the EM literature. Articles related to RA increased from one article in 1982 to 18 in 2021, and the rate of publication has increased more rapidly since 2016. Reports of lower extremity blocks (60.90%) were published most frequently in ranked-first aggregated citations. The use of thoracic nerve blocks, such as the erector spinae plane block, has increased exponentially in the past three years. The United States (41.35%) has published the most RA-related articles. Regional anesthesia administered by emergency physicians (52.63%) comprised the leading field in published articles related to RA. Most publications discussed single-shot (88.72%) and ultrasound-guided methods (55.64%).
Conclusion: This study highlights that the number of published articles related to regional anesthesia in EM has increased. Although RA research has primarily focused on lower extremity blocks, clinical researchers continue to broaden the field of study to encompass a wide spectrum of techniques and indications.
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Affiliation(s)
- Tou-Yuan Tsai
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Department of Emergency Medicine, Chiayi, Taiwan; Tzu Chi University, School of Medicine, Hualien, Taiwan
| | - Hsin-Tzu Yeh
- Chang Gung Memorial Hospital, Linkou Branch, Department of Emergency Medicine, Taoyuan, Taiwan
| | - Yu-Chang Liu
- Chi Mei Medical Center, Department of Emergency Medicine, Tainan, Taiwan
| | - Ching-Hsing Lee
- Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Department of Emergency Medicine, Keelung, Taiwan
| | - Kuan-Fu Chen
- Chang Gung University, Clinical Informatics and Medical Statistics Research Center, Taoyuan, Taiwan; Chang Gung Memorial Hospital, Community Medicine Research Center, Keelung, Taiwan; Chang Gung Memorial Hospital, Department of Emergency Medicine, Keelung, Taiwan
| | - Eric Chou
- Baylor Scott & White All Saints Medical Center, Department of Emergency Medicine, Fort Worth, Texas; Baylor University Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Jen-Tang Sun
- Tzu Chi University, School of Medicine, Hualien, Taiwan; Far Eastern Memorial Hospital, Department of Emergency Medicine, New Taipei City, Taiwan
| | - Kuo-Chih Chen
- Taipei Medical University, Shuang Ho Hospital, Department of Emergency Medicine, New Taipei City, Taiwan
| | - Yi-Kung Lee
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Department of Emergency Medicine, Chiayi, Taiwan; Tzu Chi University, School of Medicine, Hualien, Taiwan
| | - Su Weng Chau
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Department of Emergency Medicine, Chiayi, Taiwan; Tzu Chi University, School of Medicine, Hualien, Taiwan
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Exsteen OW, Svendsen CN, Rothe C, Lange KHW, Lundstrøm LH. Ultrasound-guided peripheral nerve blocks for preoperative pain management in hip fractures: a systematic review. BMC Anesthesiol 2022; 22:192. [PMID: 35729489 PMCID: PMC9210678 DOI: 10.1186/s12871-022-01720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Systematic reviews associate peripheral nerve blocks based on anatomic landmarks or nerve stimulation with reduced pain and need for systemic analgesia in hip fracture patients. We aimed to investigate the effect of ultrasound-guided nerve blocks compared to conventional analgesia for preoperative pain management in hip fractures. Five databases were searched until June 2021 to identify randomised controlled trials. Two independent authors extracted data and assessed risk of bias. Data was pooled for meta-analysis and quality of evidence was evaluated using Grades of Recommendation Assessment, Development and Evaluation (GRADE). We included 12 trials (976 participants) comparing ultrasound-guided nerve blocks to conventional systemic analgesia. In favour of ultrasound, pain measured closest to two hours after block placement decreased with a mean difference of -2.26 (VAS 0 to 10); (p < 0.001) 95% CI [–2.97 to –1.55]. In favour of ultrasound, preoperative analgesic usage of iv. morphine equivalents in milligram decreased with a mean difference of –5.34 (p=0.003) 95% CI [–8.11 to –2.58]. Time from admission until surgery ranged from six hours to more than three days. Further, ultrasound-guided nerve blocks may be associated with a lower frequency of delirium: risk ratio 0.6 (p = 0.03) 95% CI [0.38 to 0.94], fewer serious adverse events: risk ratio 0.33 (p = 0.006) 95% CI [0.15 to 0.73] and higher patient satisfaction: mean difference 25.9 (VAS 0 to 100) (p < 0.001) 95% CI [19.74 to 32.07]. However, the quality of evidence was judged low or very low. In conclusion, despite low quality of evidence, ultrasound-guided blocks were associated with benefits compared to conventional systemic analgesia.
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Affiliation(s)
- Oskar Wilborg Exsteen
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark.
| | - Christine Nygaard Svendsen
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
| | - Christian Rothe
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
| | - Kai Henrik Wiborg Lange
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Hyldborg Lundstrøm
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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5
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Puype L, Desmet M, Helsloot D, Van Belleghem V, Verelst S. The use of peripheral nerve blocks for trauma patients: a survey in Belgian emergency departments. Eur J Emerg Med 2021; 28:402-403. [PMID: 34433790 DOI: 10.1097/mej.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Puype
- Department of Emergency Medicine, University Hospitals KU Leuven, Leuven
| | | | - Dries Helsloot
- Department of Emergency Medicine, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | | | - Sandra Verelst
- Department of Emergency Medicine, University Hospitals KU Leuven, Leuven
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6
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Liang Y, Lv L, He L, Deng W, Chen C, Li J. A Randomized Controlled Trial of FNB versus FICB for Patients with Femoral Neck Fractures Before Spinal Anesthesia. Clin Interv Aging 2020; 15:1113-1119. [PMID: 32764898 PMCID: PMC7360407 DOI: 10.2147/cia.s251025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Yi Liang
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Lv Lv
- Emergency Department, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Liang He
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Wei Deng
- Department of Anesthesiology, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), Jiaxing, People's Republic of China
| | - Cai Chen
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Jingjuan Li
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
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7
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Skjold C, Møller AM, Wildgaard K. Pre-operative femoral nerve block for hip fracture-A systematic review with meta-analysis. Acta Anaesthesiol Scand 2020; 64:23-33. [PMID: 31596943 DOI: 10.1111/aas.13491] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- C. Skjold
- Department of Anaesthesiology Herlev Anaesthesia Critical and Emergency Care Science Unit Herlev Denmark
| | - A. M. Møller
- Department of Anaesthesiology Herlev Anaesthesia Critical and Emergency Care Science Unit Herlev Denmark
| | - K. Wildgaard
- Department of Anaesthesiology Herlev Anaesthesia Critical and Emergency Care Science Unit Herlev Denmark
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8
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Magidson PD, Thoburn AK, Hogan TM. Emergency Orthogeriatrics: Concepts and Therapeutic Considerations for the Geriatric Patient. Emerg Med Clin North Am 2019; 38:15-29. [PMID: 31757248 DOI: 10.1016/j.emc.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Appropriate recognition of the physiologic, psychological, and clinical differences among geriatric patients, with respect to orthopedic injury and disease, is paramount for all emergency medicine providers to ensure they are providing high-value care for this vulnerable population.
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Affiliation(s)
- Phillip D Magidson
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A1 East Suite 150, Baltimore, MD 21224, USA.
| | - Allison K Thoburn
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6098, Chicago, IL 60637, USA
| | - Teresita M Hogan
- Department of Medicine, Division of Emergency Medicine, University of Chicago School of Medicine, 5841 South Maryland Avenue, MC 6098, Chicago, IL 60637, USA
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Scala VA, Lee LS, Atkinson RE. Implementing Regional Nerve Blocks in Hip Fracture Programs: A Review of Regional Nerve Blocks, Protocols in the Literature, and the Current Protocol at The Queen's Medical Center in Honolulu, HI. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:11-15. [PMID: 31773105 PMCID: PMC6874688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hip fractures are a common cause of acute pain in elderly patients. However, pain may be undertreated due medical comorbidities. Strong evidence supports the use of regional nerve blocks to reduce preoperative pain after hip fracture. Despite recommendations for their use, regional nerve blocks may not be in widespread practice in the United States. To help promote the addition of regional nerve blocks into hip fracture protocols, this paper will provide an overview of two commonly used regional nerve blocks for hip fracture (fascia iliaca compartment block and femoral nerve block), review the regional nerve block protocols presented in 12 studies, and present the detailed protocol currently in use at The Queen's Medical Center in Honolulu, HI.
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Affiliation(s)
- Victoria A. Scala
- Victoria A. Scala MD; 1356 Lusitana St., 6th Fl. , Honolulu, HI 96813;
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10
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Zhang FF, Lv C, Yang LY, Wang SP, Zhang M, Guo XW. Pharmacokinetics of ropivacaine in elderly patients receiving fascia iliaca compartment block. Exp Ther Med 2019; 18:2648-2652. [PMID: 31572513 PMCID: PMC6755487 DOI: 10.3892/etm.2019.7838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/23/2019] [Indexed: 01/26/2023] Open
Abstract
Local anesthetic of ropivacaine was demonstrated to reduce the postoperative pain in elderly patients. This study investigated the pharmacokinetics of ropivacaine at different concentrations in elderly patients subjected to fascia iliaca compartment block. Forty patients with femoral neck fracture at American Society of Anesthesiologists (ASA) I-II status, undergoing fascia iliaca compartment block (FICB) were randomized to two groups receiving 0.7 ml/kg of solution containing 0.375% ropivacaine (group L) or 0.5% ropivacaine (group H). Samples of venous blood were obtained immediately at different time points after FICB, and the total and free plasma concentrations of ropivacaine were measured by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS). Statistical analysis was carried out using a pharmacokinetic calculation program (DAS 3.0). Visual Analogue Scale (VAS) scores were significantly decreased after FICB in both groups, and VAS score in group H was lower compared with group L. The total maximum plasma concentration (Cmax) and the free Cmax of ropivacaine in group H was higher than that in group L (P<0.05). The decrease of the total and free plasma concentration was operation time-dependent. Neither group showed signs of central nervous system and circulatory system toxicity. On the basis of these results, the concentrations of 0.375 and 0.5% ropivacaine held an efficiently analgesic effect for FICB, suggesting that ropivacaine can be employed in analgesic therapy. However, both concentrations have a potentially theoretical risk of local anesthetics poisoning, suggesting that a lower concentration may be a safer option for a single large volume of FICB.
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Affiliation(s)
- Fang-Fang Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Chen Lv
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Liu-Ying Yang
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Shi-Ping Wang
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Mei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Xiao-Wen Guo
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
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11
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Cooper AL, Nagree Y, Goudie A, Watson PR, Arendts G. Ultrasound-guided femoral nerve blocks are not superior to ultrasound-guided fascia iliaca blocks for fractured neck of femur. Emerg Med Australas 2018; 31:393-398. [PMID: 30198199 DOI: 10.1111/1742-6723.13172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine if an ultrasound-guided femoral nerve block (FNB) is superior to an ultrasound-guided fascia iliaca compartment block (FICB) in providing pain relief to patients with a neck of femur or proximal femoral fracture. METHODS A double-blind randomised controlled trial was conducted. All participants received two blocks, one active and one placebo. An active FICB was administered to 52 participants and 48 participants received an active FNB. RESULTS Analysis was completed on data collected from 100 participants. Most patients were elderly and the majority were female. Both FICB and FNB achieved clinically significant mean reductions in pain scores (2.62 for FICB and 2.3 for FNB). There was no significant difference in reduction in pain scores between the two cohorts, P = 0.408. CONCLUSIONS Ultrasound-guided FNB is not superior to ultrasound-guided FICB, with both facilitating an equivalent analgesia effect in patients with a neck of femur or proximal femur fracture.
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Affiliation(s)
- Alannah L Cooper
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Nursing and Midwifery Research, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Yusuf Nagree
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Peter R Watson
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Glenn Arendts
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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12
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Abstract
BACKGROUND A clear imperative exists to optimize the preoperative pain management of hip fracture patients. Increasingly, fascia iliaca compartment blocks (FICBs) are being effectively utilized as an adjunct to oral analgesia in the emergency department. PURPOSE We investigated the feasibility, safety, and delivery rate when junior doctors and specialist nurses are trained in FICBs delivery, alongside the introduction of a step-by-step proforma. METHODS We conducted a retrospective study of hip fractures patients presenting preinterventions (n = 138) between October and December 2014 and postinterventions (n = 246) between April and August 2015. Outcomes analyzed included delivery frequency, anesthetic dosages used, and procedure documentation. RESULTS Preintervention, FICB was performed in 40% (n = 51) of eligible patients, with an improvement to 72% (n = 160) postintervention. Postinterventions, 98% of FICBs were performed with the anesthetic dose recommended-a prescription between 75 and 100 mg of 0.25% levobupivacaine. No adverse patient outcomes, relating to the interventions implemented, were noted during the study period. CONCLUSION Delivery of FICB by junior doctors and specialist nurses in the emergency department is feasible, safe, and improves the proportion of patients receiving blocks.
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13
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Ketelaars R, Stollman JT, van Eeten E, Eikendal T, Bruhn J, van Geffen GJ. Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands. Int J Emerg Med 2018; 11:12. [PMID: 29500558 PMCID: PMC5834411 DOI: 10.1186/s12245-018-0173-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/15/2018] [Indexed: 12/26/2022] Open
Abstract
Background The treatment of acute pain in the emergency department is not always optimal. Peripheral nerve blocks using “blind” or nerve stimulator techniques have substantial disadvantages. Ultrasound-guided regional anesthesia may provide quick, safe, and effective pain relief in patients with proximal femoral fractures with severe pain. However, no evidence exists on emergency physician-performed ultrasound-guided regional anesthesia in these patients in Dutch emergency departments. We hypothesized that emergency physicians can be effectively trained to safely perform and implement ultrasound-guided femoral nerve blocks, resulting in effective pain relief in patients with proximal femoral fractures. Methods In this prospective observational study, emergency physicians were trained by expert anesthesiologists to perform ultrasound-guided femoral nerve blocks during a single-day course. Femoral nerve blocks were performed on patients with proximal femoral fractures. A system of direct supervision by skilled anesthesiologists and residents was put in place. Results A total of 64 femoral nerve blocks were performed. After 30 min, blocks were effective in 69% of patients, and after 60 min, in 83.3%. The mean reduction in pain scores after 30 and 60 min was 3.84 and 4.77, respectively (both p < 0.001). Patients reported a mean satisfaction of 8.42 (1 to 10 scale). No adverse events occurred. Conclusions Ultrasound-guided femoral nerve block is an effective, safe, and easy to learn (single-day course) procedure for emergency physicians to implement and perform in the emergency department. Patient satisfaction was high.
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Affiliation(s)
- Rein Ketelaars
- Department of Anesthesiology, Pain and Palliative medicine, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Joram T Stollman
- Emergency Department, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Emergency Department, Slingeland Hospital, Kruisbergseweg 25, 7009 BL, Doetinchem, The Netherlands
| | - Evelien van Eeten
- Emergency Department, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Ties Eikendal
- Emergency Department, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jörgen Bruhn
- Department of Anesthesiology, Pain and Palliative medicine, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Geert-Jan van Geffen
- Department of Anesthesiology, Pain and Palliative medicine, Radboud university medical center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Hartmann FVG, Novaes MRCG, Carvalho MRD. [Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review]. Rev Bras Anestesiol 2016; 67:67-71. [PMID: 27838114 DOI: 10.1016/j.bjan.2016.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/25/2015] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. OBJECTIVE To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. METHODS A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. RESULTS Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. CONCLUSION The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.
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Affiliation(s)
- Flávia Vieira Guimarães Hartmann
- Hospital de Base do Distrito Federal, Brasília, DF, Brasil; Hospital Militar de Área de Brasília, Brasília, DF, Brasil; Fundacão de Ensino e Pesquisa em Ciências da Saúde, Brasília, DF, Brasil; Escola Superior de Ciências da Saúde, Brasília, DF, Brasil.
| | - Maria Rita Carvalho Garbi Novaes
- Farmácia Hospitalar, Departamento de Saúde, Brasília, DF, Brasil; Universidad del Chile, Santiago, Chile; Fundação de Ensino e Pesquisa em Ciências da Saúde, Escola Superior de Ciências da Saúde, Brasília, DF, Brasil
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15
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Miller GW, Godrey JJ, Sagmeister ML, Lewis TL. Provision of fascia iliaca compartment block in the acute management of proximal femoral fractures: A national observational study of UK hospitals. Injury 2016; 47:2490-2494. [PMID: 27609649 DOI: 10.1016/j.injury.2016.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
AIMS Fascia iliaca compartment block (FICB) is a simple regional anaesthetic block that has been shown to be superior to other regional anaesthetic blocks with regards to success rate and analgesic efficacy in the acute management of proximal femoral fractures. The objective was to quantitatively assess the provision of FICB for patients with proximal femoral fractures in the UK. METHODS A national observational study of all acute medical trusts in the UK (n=187) was conducted. Each trust was contacted and asked to complete a freedom of information request relating to the use of regional nerve blocks in patients with a proximal femoral fracture between 2/11/2014 and 2/11/2015. The STROBE checklist was used to help design and conduct the study. RESULTS 144/187(77.0%) of medical trusts across the UK responded. Overall, 61.8% of trusts routinely performed FICB for patients with a neck of femur (NOF) fracture. The number of trusts with a specific standardised proforma for NOF fracture patients was 127/144 (88.2%), while 83/144 (57.6%) included a section relating to FICB. 50/144 (34.7%) of trusts had no hospital related guideline for FICBs in NOF fracture patients. The use of analgesia in NOF fracture patients was audited in 95/144 (66.0%) of trusts. Where FICB was administered, the procedure was typically conducted by specialists in emergency medicine (50.6%), anaesthetics (34.6%) and orthopaedics (14.8%). Common reasons for lack of FICB provision include: lack of trained staff, resumption of adequate analgesia via other methods and a perception that there is insufficient evidence for routine use of peripheral nerve blocks improving survival and outcomes. CONCLUSIONS Administration of regional nerve blocks for patients with proximal femoral fractures is increasing but variable between trusts. Further work should examine how barriers to the delivery of FICBs might be addressed.
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Affiliation(s)
- George W Miller
- Kings College London School of Medicine, Great Maze Pond, London SE1 9RT, United Kingdom.
| | - Jenna J Godrey
- County Durham and Darlington NHS Foundation Trust, North Rd, Durham DH1 5TW, United Kingdom
| | | | - Thomas L Lewis
- St George's Hospital, Blackshaw Road, London, SW17 0QT United Kingdom
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Hartmann FVG, Novaes MRCG, de Carvalho MR. Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review. Braz J Anesthesiol 2016; 67:67-71. [PMID: 28017173 DOI: 10.1016/j.bjane.2015.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/25/2015] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. OBJECTIVE To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. METHODS A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. RESULTS Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. CONCLUSION The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.
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Affiliation(s)
- Flávia Vieira Guimarães Hartmann
- Hospital de Base do Distrito Federal, Brasília, DF, Brazil; Hospital Militar de Área de Brasília, Brasília, DF, Brazil; Fundacão de Ensino e Pesquisa em Ciências da Saúde, Brasília, DF, Brazil; Escola Superior de Ciências da Saúde, Brasília, DF, Brazil.
| | - Maria Rita Carvalho Garbi Novaes
- Farmácia Hospitalar, Departamento de Saúde, Brasília, DF, Brazil; Universidad del Chile, Santiago, Chile; Fundação de Ensino e Pesquisa em Ciências da Saúde, Escola Superior de Ciências da Saúde, Brasília, DF, Brazil
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Regional Nerve Blocks For Hip and Femoral Neck Fractures in the Emergency Department: A Systematic Review. CAN J EMERG MED 2015; 18:37-47. [DOI: 10.1017/cem.2015.75] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractObjectivesHip and femoral neck fractures are common in elderly patients, who are at an increased risk of complications if their pain is suboptimally managed. This systematic review seeks to determine if regional nerve blocks reduce pain, reduce the need for parenteral opiates, and reduce complications, compared to standard pain management with opiates, acetaminophen, or NSAIDs.Data sourcesSystematic review of MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials found 401 articles, of which nine were selected for inclusion.Study selectionRandomized controlled trials including adult patients with a hip or femoral neck fracture (Population) who had a 3-in-1 femoral nerve block, traditional femoral nerve block, or fascia iliaca compartment block performed preoperatively (Intervention). Comparison must have been made with standard pain management with opiates, acetaminophen, or NSAIDs (Comparison) and outcomes must have included pain score reduction (Outcome).Data synthesisEight out of nine studies concluded pain scores were improved with the regional nerve block compared to standard pain management. A significant reduction in parenteral opiate use was seen in five out of six studies. No patients suffered life-threatening complications related to the nerve block; however, more minor complications were under-reported. Most of the studies were at a moderate to high risk of bias.ConclusionsRegional nerve blocks for hip and femoral neck fractures have a benefit in reducing pain and the need for IV opiates. The use of these blocks can be recommended for these patients. Further high-quality randomized controlled trials are required.
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Forouzan A, Masoumi K, Yadegar N, Rahim F, Feli M, Darian AA. Comparison of Femoral Nerve Block with Intravenous Morphine Sulfate for Pain Relief of Femoral Fracture. ACTA ACUST UNITED AC 2015. [DOI: 10.3923/ajsr.2015.429.435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J 2014; 32:685-9. [DOI: 10.1136/emermed-2013-203407] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 11/10/2014] [Indexed: 01/22/2023]
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Quinn LD, McLoughlin J. Femoral nerve blocks should be performed in the modern emergency department in patients with fractured femurs. Emerg Med J 2013; 31:173. [PMID: 23543226 DOI: 10.1136/emermed-2013-202585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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