Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands

Ketelaars, Rein; Stollman, Joram T.; Eeten, Evelien van; Eikendal, Ties; Bruhn, Jørgen; Geffen, Geert‐Jan van

doi:10.1186/s12245-018-0173-z

Cited by 20 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This drive to improve pain management is also the result of the development of EM as a medical specialty. Countries with deployment of EM specialists report better pain management through improved documentation of pain or implementation of new procedures, such as pro- cedural sedation or nerve blocks [31][32][33]. This beneficial impact of EM is also supported by our study, where Swiss EDs with an EM residency programme accredited by the SSERM were more likely to start documenting pain in the waiting room, and have nurse-initiated pain protocols or physician sedation protocols.…”

Section: Discussionsupporting

confidence: 66%

Pain management policies and reported practices in Swiss emergency departments: a national survey

Bourgeois

Carron

Ernst³

et al. 2019

Swiss Med Wkly

View full text Add to dashboard Cite

BACKGROUND: Acute pain is the most common complaint of patients presenting to emergency departments (EDs). Effective pain management is a core ED mission, but numerous studies have pointed to insufficient pain treatment or oligoanalgesia. According to a 1997 national survey in Swiss EDs, a validated pain scale was used in only 14%, an analgesia protocol in <5%, and 1.1% had a nurse-initiated pain protocol. Since then, numerous societal and health care factors have led to improved ED pain care. The aim of this study was to assess the state of ED pain management in Switzerland. METHODS: Hospital-based Swiss EDs open 24 hours a day and 7 days a week in 2013 were surveyed using a questionnaire. Data from 2013 were collected. Questions queried the pain management process by nurses and physicians in each ED. RESULTS:The response rate was 115 of 137 eligible EDs (84%). Pain intensity was assessed with a validated instrument in 71% of waiting rooms and in 99% of treatment areas. A nurse-initiated analgesia protocol was available in 56% of waiting rooms and in 70% of treatment areas. Physician pain protocols were available in 75%, and analgesia-sedation protocols in 51%. CONCLUSION:The pain management processes in Swiss EDs have improved over the last 17 years, and are now equivalent to other western countries. Our study did not, however, assess if these improvements resulted in better analgesia at the bedside, an important topic that will require further study.

show abstract

Section: Discussionsupporting

confidence: 66%

Pain management policies and reported practices in Swiss emergency departments: a national survey

Bourgeois

Carron

Ernst³

et al. 2019

Swiss Med Wkly

View full text Add to dashboard Cite

show abstract

“…A peripheral nerve block is not contraindicated by use of anti‐coagulants as epidural analgesia and has no sedative effects as systemic opioid treatment. Femoral nerve block (FNB) is easy to perform and can be applied by most physicians . We chose to study FNB over other blocks as our institution and other departments in Denmark use FNB as either primary pre‐operative analgesia, or as an alternative to epidural analgesia for hip fracture patients being treated with anti‐coagulants.…”

Section: Introductionmentioning

confidence: 99%

Pre‐operative femoral nerve block for hip fracture—A systematic review with meta‐analysis

Skjold

Møller

Wildgaard

2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

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. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section.How to cite this article: Skjold C, Møller AM, Wildgaard K.Pre-operative femoral nerve block for hip fracture-A systematic review with meta-analysis.

show abstract

“…POCUS can improve the safety and efficacy of invasive procedures, such as vascular catheterisation [ 246 ] and nerve blocks [ 247 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple trauma management in mountain environments - a scoping review

Sumann¹,

Moens

Brink

et al. 2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.

show abstract

Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands

Cited by 20 publications

References 25 publications

Pain management policies and reported practices in Swiss emergency departments: a national survey

Pain management policies and reported practices in Swiss emergency departments: a national survey

Pre‐operative femoral nerve block for hip fracture—A systematic review with meta‐analysis

Multiple trauma management in mountain environments - a scoping review

Contact Info

Product

Resources

About