The anaesthetic management of upper femoral fracture

Stanley, Ian

doi:10.1016/j.cacc.2005.01.002

Cited by 8 publications

(8 citation statements)

References 68 publications

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“…While the POSSUM scoring system may serve to predict serious complications and the Barthel index, the ability to ambulate at 90 days, a simple index based on clinical intuition, easy to use and not time consuming, such as the RISK-VAS scale, showed predictive value for both variables. Although the RISK-VAS scale and the other scoring systems studied have a limited value when applied to individuals rather than populations, in our experience, a RISK-VAS score of 5 or higher on admission should identify nearly all the patients who could theoretically benefit from more aggressive perioperative care (43,44). Fluid volume optimization, guided by appropriate monitoring, preoperative and 12-24-h post-operative high acuity care, multidisciplinary intervention, prompt surgery and early intensive rehabilitation, could perhaps improve the outcome and short-and long-term survival of these patients.…”

Section: Discussionmentioning

confidence: 90%

Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Burgos

Gómez-Arnau

Díez

et al. 2007

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 90%

Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Burgos

Gómez-Arnau

Díez

et al. 2007

Acta Anaesthesiol Scand

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“…Alternative agents were fentanyl, remifentanil, morphine, nitrous oxide, and sevoflurane, whereas nerve blocks were infrequently used. Use of FNB to relieve pain from a fracture of the femur at various other situations[ 8 9 ] is well known and now, is being used for positioning during spinal anaesthesia. [ 2 4 5 10 ] In the present study visual analog scale values in FNB were significantly lower than fentanyl [ Table 3 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

et al. 2014

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Background:Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl.Aims:We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB) and intra- venous (IV) fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture.Patients and Methods:In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB) and Intravenous fentanyl group (FENT). In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG) 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000) was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 μg/kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant.Results:VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020). Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049). Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027). Patient acceptance was less in group FENT (P = 0.000031).Conclusion:Femoral nerve block provides better analgesia, patient satisfaction and satisfactory positioning than IV fentanyl for position during spinal anaesthesia in patients of fracture femur.

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“…Sorenson et al6 reported that the risk of deep vein thrombosis was greater for patients receiving GA. A Cochrane review2 stated that RA was associated with a decreased mortality at one month, even though this decrease was of borderline statistical significance. Furthermore, time to ambulation may be quicker in patients receiving RA 7. A national survey in the UK8 reported that the preferred anesthetic technique was RA, especially spinal block.…”

Section: Discussionmentioning

confidence: 99%

Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur

Iamaroon

Raksakietisak

Halilamien³

et al. 2010

LRA

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PurposeFracture of femur is a painful bone injury, worsened by any movement. This prospective study was performed to compare the analgesic effects of femoral nerve block (FNB) with intravenous (IV) fentanyl prior to positioning patients with fractured femur for spinal block.Patients and methodsSixty-four ASA I–III patients aged 18–80 years undergoing surgery for femur fracture were randomized into two groups. Fifteen minutes before spinal block, the FNB group received nerve stimulator-assisted FNB with a mixture of 20 mL bupivacaine 0.5% and 10 mL normal saline 0.9%, and the fentanyl group received two doses of IV fentanyl 0.5 μg/kg with a five-minute interval between doses. Numeric rating pain scores were compared. During positioning, fentanyl in 0.5 μg/kg increments was given every five minutes until pain scores were ≤4.ResultsThere were no statistically significant differences between the groups according to pain scores, need for additional fentanyl, and satisfaction with positioning before spinal block.ConclusionWe were unable to demonstrate a benefit of FNB over IV fentanyl for patient positioning before spinal block. However, FNB can provide postoperative pain relief, whereas side effects of fentanyl must be considered, and analgesic dosing should be titrated based on pain scores. A multimodal approach (FNB + IV fentanyl) may be a possible option.

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The anaesthetic management of upper femoral fracture

Cited by 8 publications

References 68 publications

Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur

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