SummaryWe undertook a randomised, controlled trial to compare the analgesic efficacy and opioid sparing effect of nerve stimulator-guided femoral nerve block with fascia iliaca compartment block in patients awaiting surgery for fractured neck of femur. Ten-centimetre visual analogue pain scores were measured before and 2 h after the block and opioid consumption was recorded in the 12-h period after the block. One hundred and ten patients were randomly assigned. Femoral nerve block provided superior pre-operative analgesia for fractured neck of femur compared with fascia iliaca compartment block. The difference in the mean reduction of pain score after the block was 0.9 (95% CI 0-1.8); p = 0.047. Patients receiving a femoral nerve block required less morphine after the block than those receiving fascia iliaca compartment block (p = 0.041). In the UK, the target for maximum delay from diagnosis to surgery for patients with femoral neck fracture is 36 h, during which time they require adequate analgesia. Both femoral nerve block [1] and the fascia iliaca compartment block [2] are commonly used peri-operatively for analgesia in patients with a fractured neck of femur. These two techniques are used in our institution and we have equipoise as to their relative efficacy. They are either performed with a nerve stimulator to place local anaesthetic solution close to the femoral nerve or as a fascia iliaca compartment block using surface landmarks and the tactile feedback technique. All blocks are undertaken by four specialist acute pain nurses with training and extensive experience in performing these blocks. To date, over 1600 blocks have been undertaken by this team with no significant complications recorded. The two blocks have not been compared for relative efficacy when administered pre-operatively. This study was designed to resolve the question as to which technique provides superior analgesic efficacy. MethodsThe study was approved by the Local Research Ethics Committee and written informed consent was obtained from all patients. Inclusion criteria were patients presenting with isolated femoral neck fracture who had a mini-mental score [3] of ≥ 8/10 and fulfilled the requirements for full mental capacity for
Interventions need to go beyond the provision of pain management information (as in current practice), and overcome some of the erroneous beliefs held by patients. Further research is required to identify ways in which these erroneous beliefs can be overcome.
The objectives of this study were to assess patient satisfaction with the current services provided for back pain, and to increase the level of understanding from the patients' perspective on beliefs about their back pain and how it affects their daily life. The study was conducted in two parts combining both quantitative and qualitative methodology. The main findings in the study revealed a high level of satisfaction with the services provided by the physiotherapy department and mixed levels of satisfaction with the GP. The GP was seen to be an expert yet failed to exhibit up-to-date knowledge about the causes and treatments for back pain. The issue of locus of control was a dominant theme throughout the study and those with stronger internal beliefs had a more positive outlook. The study revealed gaps in the current service provided, and the need for a more easily accessed service was desired.
Some degree of pain accompanies all surgical procedures. Current evidence informs us that patients will experience significant physiological and psychological effects if this pain is not adequately treated. These effects can cause serious harm, delay recovery from surgery, and in some cases lead to persistent post-surgical chronic pain. This article briefly discusses the importance of assessing patients preoperatively and highlights how some patients will have risk factors which may lead them to experience severe postoperative pain. Approaches to postoperative pain control are focused on ways to address the inter-patient differences in response to pain and treatments and avoid periods of ineffective pain relief. A review of the commonly used analgesics, paracetamol, non-steroidal anti-inflammatory drugs, opioids and local anaesthetics, and methods of administration, is included. The final section provides a short review of emerging trends in acute pain therapy and the implications for improving patient care.
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