Analgesia and anaesthesia

2020 ◽  
pp. 281-327
Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Femoral Nerve Block ◽  
Rapid Sequence Induction ◽  
Femoral Nerve ◽  
General Anaesthetic ◽  
Intravenous Sedation ◽  
Nerve Blocks

This chapter in the Oxford Handbook of Emergency Medicine investigates analgesia and anaesthesia in the emergency department (ED). It looks at options for relieving pain, such as the analgesics aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), morphine and other opioids, Entonox®, and ketamine, and explores analgesia for trauma and other specific situations. It discusses local anaesthesia (LA) and local anaesthetic toxicity, including use of adrenaline (epinephrine) and general principles of local anaesthesia. It explores blocks such as Bier’s block, local anaesthetic nerve blocks, intercostal nerve block, digital nerve block, median and ulnar nerve blocks, radial nerve block at the wrist, dental anaesthesia, nerve blocks of the forehead and ear, fascia iliaca compartment block, femoral nerve block, and nerve blocks at the ankle. It examines sedation, including drugs for intravenous sedation and sedation in children, and discusses general anaesthesia in the emergency department, emergency anaesthesia and rapid sequence induction, difficult intubation, and general anaesthetic drugs.

scholarly journals MP024: Ultrasound-guided femoral nerve block versus fascia iliaca block for hip fractures in the emergency department: a randomized pilot study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S74-S74
Author(s):  
J. Chenkin ◽  
J.S. Lee ◽  
T. Bhandari ◽  
R. Simard
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Nerve Block ◽  
Hip Fractures ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Comfort Level ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Pain Scores

Introduction: Regional anesthesia has been shown to be an effective pain control strategy for patients presenting with hip fractures in the emergency department. There are two common methods for performing this block: the femoral nerve block (FNB) and the fascia iliaca compartment block (FICB). The objective of this pilot study is to determine whether one of these two ultrasound-guided block techniques provides superior analgesia to emergency department patients with hip fractures. Methods: Emergency physicians at a single institution were randomized to the FNB or FICB training groups. Participants completed a 2-hour practical workshop covering the technique, followed by a questionnaire to assess their comfort with the block. They were asked to perform their assigned nerve block on any patient in the ED presenting with a hip or femur fracture. Physician comfort level and patient pain scores using a visual analog scale (VAS) were recorded before and after the nerve block were recorded. Comparisons were performed using Student’s t-test and Fisher’s exact test. Results: A total of 20 physicians were enrolled in the study, 10 in the FNB group and 10 in the FICB group. There were no significant baseline differences between the groups with respect to ultrasound or nerve block experience. Following the training, 100% of participants in both the FNB group and FICB group felt comfortable performing the block. Nerve blocks were performed in 30/51 (58.8%) of eligible patients in the FNB group and 6/11 (54.5%) in the FICB group (p=1.0). On the 10-point VAS, pain scores decreased by a mean of 4.9 (SD 3.5) in the FNB group and 8.3 (SD 2.4) in the FICB group (p=0.056). In practice, physicians felt comfortable performing the FNB in 52.8% of cases, and the FICB in 85.7% of cases (p=0.21). Mean time to completion of the blocks was similar between the two groups (19 vs 18 mins, p=0.83). Conclusion: In this pilot study, we found a non-significant trend towards improved analgesia and higher physician comfort with the ultrasound-guided FICB compared with the FNB in patients with hip fractures. We found no differences in time to performing the blocks. These results require confirmation with a larger sample size.

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

CJEM ◽  
2015 ◽  
Vol 18 (4) ◽  
pp. 245-252 ◽  
Author(s):  
Madison Riddell ◽  
Maria Ospina ◽  
Jayna M. Holroyd-Leduc
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Hip Fracture ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Cochrane Central Register ◽  
Nerve Blocks ◽  
Rescue Analgesia

AbstractObjectiveHip 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 SourcesSearches 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 SelectionWe 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 ExtractionAmong 93 citations reviewed, seven trials were included. Four studies employed a single femoral nerve block, while three studies employed continuous (catheter-placed) femoral blocks. All but one of the studies were found to have a high risk of bias.Data SynthesisAll 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.ConclusionsFemoral 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.

Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department

Acute Pain ◽  
2008 ◽  
Vol 10 (1) ◽  
pp. 57
Author(s):  
C.E. Mutty ◽  
E.J. Jensen ◽  
M.A. Manka ◽  
M.J. Anders ◽  
L.B. Bone
Keyword(s):  
Emergency Department ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Femoral Fractures ◽  
Distal Femoral Fractures

scholarly journals A Pilot Randomised Clinical Trial of 3-In-1 Femoral Nerve Block and Intravenous Morphine as Primary Analgesia for Patients Presenting to the Emergency Department with Fractured Hip

2008 ◽  
Vol 15 (4) ◽  
pp. 205-211 ◽  
Author(s):  
CA Graham ◽  
K Baird ◽  
AC McGuffie
Keyword(s):  
Emergency Department ◽  
Pain Score ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Wilcoxon Test ◽  
Block Group ◽  
Pain Scores ◽  
Significant Difference ◽  
Median Pain

Background Fractured neck of femur (NOF) is a leading cause of morbidity and mortality in the elderly. Published clinical guidelines suggest early adequate analgesia as a key management aim. The femoral nerve ‘3-in-1 block’ has previously been shown to provide effective analgesia for these patients in the peri- and post-operative phase of care. The aim of this study was to examine the use of the ‘3-in-1’ femoral nerve block as primary analgesia for patients with a fractured NOF presenting to the emergency department. Methods This was a single centre pragmatic randomised controlled open-label trial comparing femoral nerve block (using a ‘3-in-1’ technique) with intravenous (IV) morphine. A convenience sample of patients presenting to the emergency department of a district general hospital with a clinically or radiologically suspected fractured NOF were recruited. They were randomised to receive either 0.1 mg/kg IV bolus of morphine or a ‘3-in-1’ femoral nerve block with 30 ml of 0.5% plain bupivacaine. Visual analogue pain scores were noted prior to treatment and at 30 minutes, 2 hours, 6 hours and 12 hours after treatment. Immediate complications such as vascular puncture or the requirement for naloxone were noted. Results Forty patients were recruited, 22 patients were randomised to IV morphine and 18 patients were randomised to ‘3-in-1’ femoral nerve block. Complete data were available for 33 patients. There was no significant difference in initial median pain score (p=0.45). Analysis using the Wilcoxon test showed a significant decrease in pain score for the morphine group (p=0.01) and the nerve block group (p<0.01) at 30 minutes compared with baseline. Analysis using the Mann-Whitney U test between median pain scores at each time point showed a significant lower pain score in the nerve block group at 30 minutes (p=0.046). There were no immediate complications in either group. Conclusion Our results suggest that a ‘3-in-1’ femoral nerve block is at least as effective as IV morphine when used as primary analgesia for patients with fractured NOF. Our results suggest that the femoral nerve block may provide better analgesia at 30 minutes. Further larger scale randomised trials are warranted.

scholarly journals Defining the minimal effective volume and amount of lidocaine to perform a femoral nerve block under ultrasound control

2020 ◽  
Author(s):  
Valery Piacherski ◽  
Aliaksei Marachkou
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Peripheral Nerves ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
The Body ◽  
Effective Volume ◽  
Nerve Blocks ◽  
Nerve Blockade

Abstract BackgroundThe application of the combination of local anesthetics (LA) in some parts of the body increases the amount of LA and plasma concentration. The aim of our research was to define the minimal effective volume and amount of lidocaine with added adrenaline (1:200,000) to perform a femoral nerve block under ultrasound control and with neurostimulation. MethodsFemoral nerve blockade was performed with the following lidocaine solutions: 0.75% -10 ml, 7.5 ml; 1% -20ml, 15ml, 10ml, 7.5ml, 5ml; 1.5% -5ml, 4ml; 2% -5 ml, 4 ml; 3% -5ml, 4ml, 3ml; 4% -5 ml, 4 ml, 3 ml, 2.5 ml. All blocks were performed with added adrenaline (1:200,000). In all, 181 blocks of the femoral nerve, in combination with sciatic nerve blocks, were carried out with the help of the electrostimulation of peripheral nerves, and under ultrasound. The quality of motor and sensory blocks was assessed after 45 min of administration of the femoral nerve block. ResultsA total of 181 femoral nerve blocks, in combination with sciatic nerve blocks, were used via the help of electrostimulation of the peripheral nerves (EPN), and under ultrasound (US) control. The femoral nerve blockade was effective with the following lidocaine solutions: 0.75% -10 ml (75mg); 1% -20ml, 15ml, 10ml, 7.5ml (75mg); 1.5% -5ml (75mg); 2% -5 ml (100 mg); 3% -5ml (150mg); 4% -5 ml (200mg). Femoral blockade was ineffective when using the following solutions of lidocaine: 0.75% - 7.5ml (56.25 mg); 1% - 5ml (50mg); 1.5% - 4ml (60mg, No spread along the entire circumference of the nerve - NSAECN); 2% - 4 ml (80mg, NSAECN); 3% - 4ml (120mg NSAECN), 3 ml; 4% - 4 ml (160 mg, NSAECN), 3 ml, 2.5 ml. ConclusionFor a complete motor and sensory block of the femoral nerve: the minimum effective volume of local anesthetics was 5 ml; and the minimum effective amount of lidocaine was 75 mg. А complete block of the femoral nerve was achieved only with the spreading of local anesthetic along the whole circumference of the femoral nerve.

scholarly journals Evaluation of Efficacy of Femoral Nerve Block on Pain and Anxiety in Acute Fractures of the Femur in the Emergency Department

2021 ◽  
Author(s):  
Shiv Shanker Tripathi ◽  
Suruchi Ambasta ◽  
Swagat Mahapatra ◽  
Anurag Agarwal ◽  
Shivani Rastogi
Keyword(s):  
Emergency Department ◽  
Pain Relief ◽  
Nerve Block ◽  
Distal Femur ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Ultrasound Guided ◽  
Vas Score ◽  
The Mean ◽  
Fractures Of The Femur

Introduction: Fractures around the hip and fractures of the femur are commonly encountered in the Emergency Department (ED). Effective control of pain in these fractures is of critical importance for proper radiography, reduction and splintage. Traditionally, systemic analgesics have been used for pain relief which had its own limitations both in terms of pain relief and relaxation. Use of Femoral Nerve Block (FNB) in acute fractures around the hip and femur has been a challenge and, evaluation of this procedure has been the subject of research recently in ED. Aim: To evaluate the efficacy of FNB in decreasing pain and anxiety in acute fractures of the femur. Materials and Methods: Prospective interventional study was conducted at a tertiary care centre with well-defined inclusion and exclusion criteria. Eighty four patients with fractures around the hip, fractures of the shaft and distal femur underwent ultrasound guided FNB for performance of retrieval procedures. Visual analog scale (VAS) score for pain and Hamilton Anxiety Score (HAM-A) score for anxiety were used as parameter both for pre and postblock to assess the effectiveness. Subjective assessment of the patients comfort level was also done. Statistical analysis of all data obtained was done using SPSS 21.0. Results: Study group (n=84) included in the evaluation were homogenous in terms of age and sex distribution. The mean±SD VAS score preoperatively was 72.93±10.91. At 30 minutes and 4 hours postblock,the mean±SD VAS scores were 18.65±5.25 and 13.88±6.05, respectively. There was statistically significant difference in VAS score at 30 minutes (p=0.004) and 4 hours (p=0.015). The mean Hamilton Anxiety score at preblock and 4 hour postblock was 27.05±5.94 and 8.07±3.7, respectively. The overall HAM-A score comparison showed that there was statistically significant change after 4 hours postblock (p=0.013) showing significant decrease in anxiety levels. All patients were satisfied by the comfort and ease of shifting after block. Intergroup analysis of fractures around the hip (Neck femur, Trochanter) and fractures of the shaft (Shaft femur and distal femur) revealed equal efficacy of the femoral block. Conclusion: Ultrasound guided FNB is an easy and safe means of providing pain and anxiety relief to patients with the fracture of the femur (neck femur, per-trochanteric femur, shaft femur or distal femur) in the ED. At the same time, it decreases the need of systemic analgesia.

Use of ultrasound to facilitate accurate femoral nerve block in the emergency department

2009 ◽  
Vol 21 (2) ◽  
pp. 124-130 ◽  
Author(s):  
Nicole Reid ◽  
Julian Stella ◽  
Matt Ryan ◽  
Michael Ragg
Keyword(s):  
Emergency Department ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve
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