Efficacy of Ultrasound-guided 3-in-1 Femoral Nerve Block for Pain Management in Elderly Patients Presenting to the Emergency Department with hip Fractures: A Randomized Controlled Trial

Javali, Ramesh Babu Homanna; Gb, Suraj; Akkamahadevi, P; Srinivasarangan, Madhu; J, Sriharsha; S, Nisarg; Sb, Adarsh

doi:10.21088/ijaa.2349.8471.6319.41

Cited by 2 publications

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“…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].…”

Section: Discussionmentioning

confidence: 61%

“…This is a novel departure from current practice, and increases the internal validity of the results [6,30,31]. Unlike previous studies, follow-up extended pain assessment to the first 48 h of care and opioids and FNB-related adverse event monitoring to the entire hospital stay [22,26,28,29].…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Gerlier,

Mijahed,

Fels

et al. 2023

European Journal of Emergency Medicine

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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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