Use of ultrasound to facilitate accurate femoral nerve block in the emergency department

Abstract

A more complete blockade is achieved earlier using the US-assisted technique. The US-assisted technique will become the technique of choice for FNB in this department.

Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial

“…Femoral (thigh) fractures are an important clinical problem associated with high morbidity and mortality, especially in the elderly (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Although systemic opioids such as morphine and fentanyl are among the most frequently used analgesic agents administered by emergency medical and ambulance services, there is evidence to suggest that regional anesthesia may be an alternative for managing acute pain after a femoral fracture (14-23).…”

Ultrasound Guided Femoral Nerve Blocks and the Management of Elder Patients with Hip Fractures

“…This allows a clinician the ability to guide the needle and safely insert anesthetic solution around the nerve (Figure 1). Various studies have been conducted to demonstrate the ease and safety of performing ultrasound guided FNB [15,16,[20][21][22]. Anesthesia and Emergency Medicine literature has demonstrated ultrasound guided FNBs can lead to faster and improved quality of nerve blocks [9,11,16,20,21].…”

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

“…We feel that, had the authors used ultrasound when performing the blocks, they might have been able to include the three cases in whom it was difficult to identify the femoral nerve solely using a nerve stimulator. The effectiveness of fascia iliaca block has been demonstrated to be improved by using ultrasound compared with a 'loss of resistance' technique [3].…”

“…Capdevila et al's original comparative study used 30 ml [2] and many authors advocate up to 40 ml [3]. There are also descriptions of multiple fascial layers in the inguinal area, and so using the blind 'double-pop' technique, one could deposit local anaesthetic between the wrong layers and not the fascia iliaca compartment as intended.…”

“…First, the authors did not standardise to one nerve localisation technique (anatomical landmark or nerve stimulator or ultrasound) and therefore the degree to which the observed difference occurred because of differences in technique rather than nerve anatomy cannot be quantified. Indeed, evidence favouring ultrasound to guide local anaesthetic infiltration for peripheral nerve blockade [2] including nerve blocks in patients with femoral trauma [3], together with the increasing use of ultrasound in regional anaesthesia practice, suggest their study could have been more widely applicable had it com-pared the two nerve blocks both performed under ultrasound guidance. Ultrasound has the added advantage of avoiding painful movement in the fractured limb during nerve stimulation.…”