Femoral Nerve Block for Pain Management of Femoral Fractures in the Emergency Department: Evidence Based Topic Review

Background: Opioid consumption and patient satisfaction are influenced by a surgeon’s pain-management protocol as well as the use of adjunctive pain mediators. Two commonly utilized adjunctive pain modifiers for anterior cruciate ligament (ACL) reconstruction are femoral nerve blockade and intra-articular injection; however, debate remains regarding the more efficacious methodology. Hypothesis: We hypothesized that intra-articular injection with ropivacaine and morphine would be found to be as efficacious as a femoral nerve block for postoperative pain management in the first 24 hours after bone–patellar tendon–bone (BTB) ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Charts were retrospectively reviewed for BTB ACL reconstructions performed by a single pediatric orthopaedic surgeon from 2013 to 2019. Overall, 116 patients were identified: 58 received intra-articular injection, and 58 received single-shot femoral nerve block. All patients were admitted for 24 hours. Pain scores were assessed every 4 hours. Morphine milligram equivalents (MMEs) consumed were tabulated for each patient. Results: Opioid use was 24.3 MMEs in patients treated with intra-articular injection versus 28.5 MMEs in those with peripheral block ( P = .108). Consumption of MMEs was greater in the intra-articular group in the 0- to 4-hour period (7.1 vs 4.6 MMEs; P = .008). There was significantly less MME consumption in patients receiving intra-articular injection versus peripheral block at 16 to 20 hours (3.2 vs 5.6 MMEs; P = .01) and 20 to 24 hours (3.8 vs 6.5 MMEs; P < .001). Mean pain scores were not significantly different over the 24-hour period (peripheral block, 2.7; intra-articular injection, 3.0; P = .19). Conclusion: Within the limitations of this study, we could identify no significant difference in MME consumption between the single-shot femoral nerve block group and intra-articular injection group in the first 24 hours postoperatively. While peripheral block is associated with lower opioid consumption in the first 4 hours after surgery, patients receiving intra-articular block require fewer opioids 16 to 24 hours postoperatively. Given these findings, we propose that intra-articular injection is a viable alternative for analgesia in adolescent patients undergoing BTB ACL reconstruction.

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Peer review report 2 on “Comparison of femoral nerve block and fascia iliaca block for pain management in total hip arthroplasty: A meta-analysis”

International Journal of Surgery ◽

10.1016/j.ijsu.2017.08.015 ◽

2017 ◽

Vol 37 ◽

pp. 476

Author(s):

Michael Jennings Boscoe

Keyword(s):

Pain Management ◽

Total Hip Arthroplasty ◽

Peer Review ◽

Nerve Block ◽

Hip Arthroplasty ◽

Femoral Nerve Block ◽

Meta Analysis ◽

Femoral Nerve ◽

Total Hip ◽

Fascia Iliaca Block

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Perioperative Pain Management in Femoral Shaft Fractures. Continuous Femoral Nerve Block vs Systemic Pain Therapy

Regional Anesthesia and Pain Medicine ◽

10.1097/00115550-200809001-00146 ◽

2008 ◽

Vol 33 (Sup 1) ◽

pp. e77

Author(s):

G. Chalmouki ◽

N. Lekka ◽

T. Lappas ◽

E. Paraskeua ◽

A. Mela ◽

...

Keyword(s):

Pain Management ◽

Nerve Block ◽

Pain Therapy ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Continuous Femoral Nerve Block ◽

Perioperative Pain Management

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Analgesia and anaesthesia

Oxford Handbook of Emergency Medicine ◽

10.1093/med/9780198784197.003.0007 ◽

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.

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