Femoral nerve blocks for the treatment of acute pre‐hospital pain: A systematic review with meta‐analysis

Abstract

Background: Pain management is one of the most important interventions in the emergency medical services. The femoral nerve block (FNB) is, among other things, indicated for pre-and post-operative pain management for patients with femoral fractures but its role in the pre-hospital setting has not been determined. The aim of this review was to assess the effect and safety of the FNB in comparison to other forms of analgesia (or no treatment) for managing acute lower extremity pain in adult patients in the pre-hospital setting. Methods: A systematic review (PROSPERO registration (CRD42018114399)) was conducted. The Cochrane and GRADE methods were used to assess outcomes. Two authors independently reviewed each study for eligibility, extracted the data and performed risk of bias assessments. Results: Four studies with a total of 252 patients were included. Two RCTs (114 patients) showed that FNB may reduce pain more effectively than metamizole (mean difference 32 mm on a 100 mm VAS (95% CI 24 to 40)). One RCT (48 patients) compared the FNB with lidocaine and magnesium sulphate to FNB with lidocaine alone | 1039 RAATINIEMI ET Al.

Opioids for Treatment of Pre-hospital Acute Pain: A Systematic Review

“…It is part of a comprehensive literature review (PROSPERO registration number: CRD42018114399) of studies on pre-hospital analgesia, with the aim to provide the basis for a clinical guideline on the subject. The review has similar methodologies as described elsewhere [ 21 , 22 ]. The task force conducting the guideline was appointed by the Scandinavian Society of Anaesthesia and Intensive care medicine (SSAI) [ 23 ].…”

“…Three authors (LR and either KDF or PKH) independently assessed all titles and abstracts identified from the search according to the inclusion criteria, as described in our previous reviews [ 21 , 22 ]. References considered to be potentially relevant were collected and assessed independently in full text by two assessors using the same inclusion criteria [ 21 , 22 ]. Disagreements were resolved by discussion among all three assessors.…”

“…As described elsewhere [ 21 , 22 ], we extracted data pertaining to full reference; study design and country in which the study was conducted; characteristics of the population (e.g., number of patients, age, gender, cause of pain, setting, and context); type and dose of analgesics given; competency of the healthcare personnel who administered the analgesic; comparison/control intervention; attrition; outcomes; and follow-up times.…”

Periphere Regionalanästhesieverfahren – Standards im Wandel?!

“…Dass es dennoch lohnt, dieses Thema wissenschaftlich adäquat zu beleuchten, zeigen erste Daten aus Deutschland zur RA bei dislozierten Extremitätenfrakturen, die positive Effekte nahelegen [33]. Umgekehrt zeigt eine erste Metaanalyse zur Analgesie bei proximalen Femurfrakturen den Bedarf an hochwertigen Studien mit adäquaten Vergleichsgruppen [34].…”

Regional Anesthesia in the Austere Environment: Lessons Learned from Current Out-of-Hospital Practice

“…Lidocaine, bupivacaine, and ropivacaine have all been used within the out-of-hospital setting. 16,20 Local anesthetics have also been shown to still be effective at lower temperatures, with slight delays in onset times but no significant difference in duration of action. 21 While there are inconclusive data about the analgesic effect provided by warmed local anesthetics, there is limited information about the impact on the action time.…”