Trends in the Use of Regional Anesthesia

Cozowicz, Crispiana; Poeran, Jashvant; Zubizarreta, Nicole; Mazumdar, Madhu; Memtsoudis, Stavros G.

doi:10.1097/aap.0000000000000342

Cited by 74 publications

(29 citation statements)

References 40 publications

(52 reference statements)

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“…There is growing evidence of the advantages of peripheral nerve blocks . A peripheral nerve block is one of many analgesic methods to treat pre‐operative pain caused by hip fractures .…”

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

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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.

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“…There is growing evidence of the advantages of peripheral nerve blocks . A peripheral nerve block is one of many analgesic methods to treat pre‐operative pain caused by hip fractures .…”

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

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“…Peripheral nerve blocks are gaining popularity for orthopaedic limb surgery , but little is known about how patients experience peripheral nerve blocks as both anaesthesia and pain control. Peripheral nerve blocks are considered safe; they reduce postoperative opioid consumption and their long‐lasting effect improves patient satisfaction in elective surgery .…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences

et al. 2017

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Summary Peripheral nerve blocks are popular as a mode of anaesthesia for limb surgery and their beneficial effects are well documented in elective surgery. However, concerns have been raised about potential rebound pain outweighing the benefits in acute ankle fracture surgery. Furthermore, pain scores and morphine consumption do not provide a full picture, as pain is subjective. To evaluate the clinical usefulness of peripheral nerve blocks, we explored patients’ expectations and experiences by means of semi‐structured interviews analysed with systematic text condensation. We obtained ethical approval and informed consent and sampled purposively among adult patients scheduled for ankle surgery with nerve blocks as the primary mode of anaesthesia. Patients were interviewed within 48 h postoperatively. Data saturation was reached after 13 interviews. We found that, despite pre‐emptive ibuprofen and paracetamol, some patients did experience excruciating rebound pain for up to 2 h, although most had little or no pain. The patients had doubts about what to do when the block wore off, which led to a risk of unnecessary pain levels or morphine overuse. Patients had difficulty understanding the effect and course of the nerve blocks. They had misunderstandings regarding the blocks’ effect on sensation, resulting in fear of feeling pain during surgery and of permanent nerve damage after surgery. However, patients valued the mental alertness, ability to ambulate and efficient pain relief provided by the blocks. We recommend that patients be given thorough and repeated information as we feel this is crucial in preventing undesirable responses from patients, and is likely to increase the overall clinical usefulness of nerve blocks in acute limb surgery.

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“…For some surgeries performed in France (open surgery hernia repair; lower limb orthopedic surgery; hand and upper limb orthopedic surgery), anesthesiologists deployed in mission preferentially chose regional anesthesia. Regional anesthesia in austere environments has several advantages: low or no need for perioperative oxygen; good postoperative analgesia, especially among ambulatory surgery patients; and early discharge from the postoperative recovery room and hospital [26–28]. Neuraxial anesthesia, particularly spinal anesthesia, is frequently used for the majority of lower limb orthopedic surgeries, and also for urologic and visceral surgeries [26].…”

Section: Discussionmentioning

confidence: 99%

Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases

et al. 2019

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BackgroundMilitary anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations.ObjectiveThis study aimed to describe and analyze French anesthetic activity in a deployed military setting.MethodsBetween October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital.ResultsDuring the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations.ConclusionIn the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.

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Trends in the Use of Regional Anesthesia

Cited by 74 publications

References 40 publications

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

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

Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences

Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases

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