Ultrasound‐guided femoral nerve blocks are not superior to ultrasound‐guided fascia iliaca blocks for fractured neck of femur

Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities. Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds, International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l. This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment. Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.

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Optimal positioning of local anaesthetic in femoral nerve block prior to operative fixation of fractured neck of femur

European Journal of Anaesthesiology ◽

10.1097/00003643-201106001-00386 ◽

2011 ◽

Vol 28 ◽

pp. 121

Author(s):

S. Szucs ◽

D. Morau ◽

G. Iohom

Keyword(s):

Nerve Block ◽

Local Anaesthetic ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Operative Fixation

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Utilizing Ultrasound-Guided Femoral Nerve Blocks and Fascia Iliaca Compartment Blocks for Proximal Femur Fractures in the Emergency Department

Advanced Emergency Nursing Journal ◽

10.1097/tme.0000000000000247 ◽

2019 ◽

Vol 41 (2) ◽

pp. E2

Keyword(s):

Emergency Department ◽

Proximal Femur ◽

Femoral Nerve ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Proximal Femur Fractures ◽

Femur Fractures

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

CJEM ◽

10.1017/cem.2016.165 ◽

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.

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