Ultrasonographic Guidance Reduces the Amount of Local Anesthetic for 3-in-1 Blocks

Marhofer, Peter; Schrögendorfer, Klaus F.; Wallner, Thomas; Koinig, Herbert; Mayer, N.; Kapral, Stephan

doi:10.1097/00115550-199823060-00013

Cited by 111 publications

(158 citation statements)

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“…However, other studies suggest that ultrasound guidance may increase the efficacy and feasibility of this procedure in the ED 26 and may be superior to other nerve block techniques in regard to onset of action and amount of anaesthetic required. 27 Both catheter-placed and single femoral nerve block procedures were included in this review. Although both techniques showed benefits in terms of pain reduction, there are important differences between the two techniques that may have important clinical implications.…”

Section: Discussionmentioning

confidence: 99%

Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

Riddell

Ospina

Holroyd‐Leduc

2015

CJEM

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Objective: Hip fractures are a common source of acute pain amongst the frail elderly. One potential technique to adequately manage pain in this population is the femoral nerve block. The objective of this systematic review was to provide updated evidence for the use of femoral nerve blocks as a pain management technique for older hip fracture patients in the emergency department (ED). Data Sources: Searches of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were conducted between December 2010 and May 2014. The reference list of a previous systematic review was also searched. Study Selection: We included randomized control trials examining the use of femoral nerve blocks in the ED among older adults (65 years of age or older) with acute hip fracture. Data Extraction: Among 93 citations reviewed, seven trials were included. Four studies employed a single femoral nerve block, while three studies employed continuous (catheterplaced) femoral blocks. All but one of the studies were found to have a high risk of bias. Data Synthesis: All studies reported reductions in pain intensity with femoral nerve blocks. All but one study reported decreased rescue analgesia requirements. There were no adverse effects found to be associated with the femoral block procedure; rather, two studies found a decreased risk of adverse events such as respiratory and cardiac complications. Conclusions: Femoral nerve blocks appear to have benefits both in terms of decreasing the pain experienced by older patients, as well as limiting the amount of systemic opioids administered to this population. RÉSUMÉObjectif: Les fractures de la hanche sont une cause fréquente de douleur aiguë chez les personnes âgées fragiles. L'un des moyens possibles de soulager efficacement la douleur dans ce groupe de personnes est le bloc fémoral. La revue systématique visait à recueillir des données probantes à jour sur le bloc fémoral comme moyen de soulagement de la douleur causée par les fractures de la hanche, chez les personnes âgées, au service des urgences (SU). Aucun effet indésirable n'a été associé au bloc fémoral; au contraire, les auteurs ont même constaté, dans deux études, une diminution du risque d'événement indésirable tel que des complications cardiaques ou respiratoires. Conclusions: Les blocs fémoraux semblent avantageux tant sur le plan du soulagement de la douleur chez les personnes âgées que sur celui de l'administration d'opioïdes à action générale, dans ce segment de la population.

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Section: Discussionmentioning

confidence: 99%

Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

Riddell

Ospina

Holroyd‐Leduc

2015

CJEM

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“…Por un lado, la técnica analgésica para realizar el bloqueo ha sido muy precisa y cuidadosa en todo momento, utilizando conjuntamente la ecografía y la neuroestimulación para localizar la estructura nerviosa a bloquear (el nervio femoral a nivel inguinal), mejorando así la efectividad, seguridad y calidad del bloqueo 10,18,19,123,124 , sin haberse objetivado fallos del bloqueo en ninguno de los casos realizados. Sin embargo, muchos estudios siguen basando la técnica en la neuroestimulación nerviosa para localizar el nervio, aumentando así la tasa de fallos o la cualidad del bloqueo analgésico.…”

Section: Tiempo De Analgesia Del Bloqueo Femoralunclassified

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Morales-Muñoz

Sánchez-Ramos

Díaz-Lara

et al. 2017

Revista Española de Anestesiología y Reanimación

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“…7 In two RCTs (combined n = 100), compared to neurostimulation, ultrasonography provided a quicker onset (13-16 ± 6-14 vs 26-27 ± 12-16 min; P < 0.05) and a denser combined sensory block of the femoral, lateral femoral cutaneous and obturator nerves (4-15 ± 5-10 vs 21-27 ± 11-19% of sensation to pinprick compared to the unanesthetized contralateral limb; P < 0.05). 18,19 A recent study has also reported better blockade of all three nerves with echoguidance. 11 In 1988, to improve obturator nerve block seen with the 3-in-1 technique, Dalens et al 20 introduced the fascia iliaca compartment block, a method by which LA was injected immediately posterior to the fascia iliaca while firm compression was applied distal to the puncture site.…”

Section: Techniquesmentioning

confidence: 92%

“…1 Although sensible and anatomically sound, this contention has not been confirmed with RCTs. Loss of resistance, elicitation of paresthesiae, neurostimulation and ultrasonography have all been investigated as adjunctive modalities for nerve localization in 3-in-1 block: 7,11,[18][19][20][21][22] although the results of these studies can be extrapolated to femoral blockade, further RCTs are nonetheless required to investigate their use in the context of a specific femoral nerve block technique. Finally, as evidenced by the confusion in terminology, the difference between 3-in-1 and femoral nerve block requires elucidation.…”

Section: Femoral Nerve Blockmentioning

confidence: 99%

A review of approaches and techniques for lower extremity nerve blocks

Tran

Clemente

Finlayson

2007

Can J Anesth/J Can Anesth

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Purpose: The purpose of this narrative review is to summarize the evidence derived from randomized controlled trials (RCTs) regarding approaches and techniques for lower extremity nerve blocks.Source: Using the MEDLINE (January 1966 to April 2007 and EMBASE (January 1980 to April 2007 databases, medical subject heading (MeSH) terms "lumbosacral plexus", "femoral nerve", "obturator nerve", "saphenous nerve", "sciatic nerve", "peroneal nerve" and "tibial nerve" were searched and combined with the MESH term "nerve block" using the operator "and". Keywords "lumbar plexus", "psoas compartment", "psoas sheath", "sacral plexus", "fascia iliaca", "three-in-one", "3-in-1", "lateral femoral cutaneous", "posterior femoral cutaneous", "ankle" and "ankle block" were also queried and combined with the MESH term "nerve block". The search was limited to RCTs involving human subjects and published in the English language. Forty-six RCTs were identified. Principal findings:Compared to its anterior counterpart (3-in-1 block), the posterior approach to the lumbar plexus is more reliable when anesthesia of the obturator nerve is required. The fascia iliaca compartment block may also represent a better alternative than the 3-in-1 block because of improved efficacy and efficiency (quicker performance time, lower cost). For blockade of the sciatic nerve, the classic transgluteal approach constitutes a reliable method. Due to a potentially shorter time for sciatic nerve electrolocation and catheter placement than for the transgluteal approach, the subgluteal approach should also be considered. Compared to electrolocation of the peroneal nerve, electrostimulation of the tibial nerve may offer a higher success rate especially with the transgluteal and lateral popliteal approaches. Furthermore, when performing sciatic and femoral blocks with low volumes of local anesthetics, a multiple-injection technique should be used. MeSH « nerve block » à l'aide de l'opérateur « and ». Les mots clés « lumbar plexus », « psoas compartment », « psoas sheath », « sacral plexus », « fascia iliaca », « lateral Conclusions Objectif : L'objectif de cet examen narratif est de résumer les données probantes dérivées d'études randomisées contrôlées (ERC) concernant les approches et techniques pour les blocs nerveux du membre inférieur. Source : A l'aide des bases de données MEDLINE (janvier 1966 à avril 2007) et EMBASE (janvier 1980 à avril 2007), les termes MeSH (vedette-matière médicale) « lumbosacral plexus », « femoral nerve », « obturator nerve », « saphenous nerve », « sciatic nerve », « peroneal nerve » et « tibial nerve » ont été recherchés et combinés au terme

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Ultrasonographic Guidance Reduces the Amount of Local Anesthetic for 3-in-1 Blocks

Cited by 111 publications

References 0 publications

Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

A review of approaches and techniques for lower extremity nerve blocks

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