Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomised controlled trial

Abstract

ObjectiveFractured neck of femur is a severely painful condition with significant mortality and morbidity. We investigated whether early and continuous use of femoral nerve block can improve pain on movement and mobility after surgery in older participants with fragility neck of femur fracture.DesignProspective single-centre, randomised controlled pragmatic trial.SettingSecondary care, acute National Health Service Trust, UK.ParticipantsParticipants admitted with a history and examination suggesting fractured neck of femur.InterventionImmediate continuous femoral nerve block via catheter or standard analgesia.Outcome measuresPrimary outcome measures were Cumulative Dynamic Pain score and Cumulated Ambulation Score from surgery until day 3 postoperatively. Secondary outcome measures included pain scores at rest, cumulative side effects (nausea and constipation), quality of life (measured by EuroQOL 5 D instrument (EQ-5D) score) at day 3 and day 30, and rehabilitation outcome (measured by mobility score).Results141 participants were recruited, with 23 excluded. No significant difference was detected between Cumulative Dynamic Pain Score (standard care (n=56) vs intervention (n=55) 20 (IQR 15–24) vs 20 (15–23), p=0.51) or Cumulated Ambulation Score (standard care vs intervention 6 (5–9) vs 7 (5–10), p=0.76). There were no statistically different differences in secondary outcomes except cumulative pain at rest: 5 (0.5–6.5) in the standard care group and 2 (0–5) in the intervention group (p=0.043).ConclusionsEarly application of continuous femoral nerve block compared with standard systemic analgesia did not result in improved dynamic pain score or superior postoperative ambulation. This technique may provide superior pain relief at rest. Continuous femoral nerve block did not delay initial control of pain or mobilisation after surgery.Trial registration numberISRCTN92946117; Pre-results.

Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: an observational study

“…The fractures of the proximal femur, including the fracture of the neck of femur, intertrochanteric, and subtrochanteric fractures, are a common orthopedic emergency, especially in the geriatric population [1]. These fractures are extremely painful and associated with significant morbidity and mortality [2,3]. Regional anesthesia is preferred during surgery in these patients.…”

Ultrasound-guided peripheral nerve blocks for preoperative pain management in hip fractures: a systematic review

“…Full text screening was performed in 118 of these studies and after this procedure 15 studies were found to fulfil the inclusion criteria [ 15 – 29 ]. However, three trials were subsequently excluded; one trial was only published as a detailed abstract and the author did not respond to our inquiry of supplementary data [ 24 ]; one study had to be excluded due to the participants in the intervention group not being randomised directly to US-PNBs [ 25 ] and one trial [ 26 ] permitted a single shot US-guided femoral nerve block as rescue treatment in the standard care (control). Most common reasons for exclusion at full text screening were no US-guidance, not RCT or wrong comparator.…”

The Analgesic Efficacy of Different Techniques Surrounding Regional Anesthesia of the Lumbar Plexus and its Terminal Branches for Hip Fracture Surgeries

“…In total, twenty-five studies met the inclusion criteria[12, 14, 16, 20, 23, 27, 28, 33, 34, 38, 47, 51, 59, 60, 62, 65, 57, 66, 74, 77, 80, 82, 83, 85, 86]. Included studies date from 2007 to 2019.…”