Use of femoral nerve blocks in adults with hip fractures

2013 ◽  
Vol 27 (52) ◽  
pp. 49-55 ◽  
Author(s):  
Mandy Jayne Layzell
Keyword(s):  
Hip Fractures ◽  
Femoral Nerve ◽  
Nerve Blocks

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.

Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures

2010 ◽  
Vol 28 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Francesca L. Beaudoin ◽  
Arun Nagdev ◽  
Roland C. Merchant ◽  
Bruce M. Becker
Keyword(s):  
Elderly Patients ◽  
Hip Fractures ◽  
Femoral Nerve ◽  
Ultrasound Guided ◽  
Nerve Blocks

scholarly journals LO12: The utility of femoral nerve blocks in the emergency department; a national survey of practice

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S31
Author(s):  
J. Ringaert ◽  
J. Broughton ◽  
M. Pauls ◽  
I. Laxdal ◽  
N. Ashmead
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Femoral Nerve ◽  
Comfort Level ◽  
Emergency Physicians ◽  
First Line ◽  
Nerve Blocks ◽  
Canadian Association ◽  
The University

Introduction: Approximately 30,000 hip fractures occur annually in Canada, and the incidence will increase with an aging population. Pain control remains a challenge with these patients, as many are elderly and prone to delirium. Regional anesthesia has shown to be very effective with minimal risks, but it is not clear how often emergency physicians are using this technique to provide analgesia for patients with proximal hip fractures. This is the first Canada-wide survey to evaluate the use of regional anaesthesia in the emergency department for hip fractures. It also evaluates physician comfort level with performing these blocks, perceived educational needs in this area, and barriers to performing nerve blocks. Methods: A 13-question survey was sent to 1041 members of the Canadian Association of Emergency Physicians via email in January and February of 2016. Data was collected and analysed using an online collection program called “Survey Monkey”. Ethics approval was obtained through the University of Manitoba Research Ethics Board. Results: 272 Emergency physicians and residents took part in the survey. The majority of respondents (75.9%) choose intravenous opioids as their first line of analgesia and only 7.6% use peripheral nerve blocks (PNB) as their first line choice for analgesia in hip fracture. In response to practitioner comfort with PNBs for hip fractures, most were not at all confident (45.0%) in their ability and many respondents have never performed a nerve block for a hip fracture (53.9%). The most commonly identified barriers to performing PNBs include lack of training, the time to perform the procedure and a lack of confidence. A larger percentage of respondents (34.2%), identified having had no training and no knowledge of how to perform PNBs for hip fractures. Conclusion: The vast majority of Canadian emergency physicians who took part in this survey do not utilize PNBs as a method of pain management for hip fractures. Over half have never performed one of these procedures and many have never received training in how to do so. Future efforts should focus on improving access to education, disseminating information regarding the effectiveness of PNB, and addressing logistical barriers in the ED.

scholarly journals Emergency Department Femoral Nerve Blocks and 1-Year Mortality in Fragility Hip Fractures

2019 ◽  
Vol 10 ◽  
pp. 215145931989389 ◽  
Author(s):  
Michael Darren Polischuk ◽  
Nrusheel Kattar ◽  
Ashwin Rajesh ◽  
Tony Gergis ◽  
Kieran King ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hip Fractures ◽  
Femoral Nerve ◽  
Early Mobilization ◽  
Opioid Use ◽  
Retrospective Case ◽  
Nerve Blocks ◽  
Significant Difference ◽  
Insight Into ◽  
Control Study

Objective: Femoral nerve blocks (FNBs) for fragility hip fractures have benefits in improving pain relief and early mobilization while decreasing opioid use and rates of pneumonia. However, no study has looked at 1-year mortality outcomes for this intervention. This study aims to provide insight into 1-year outcomes. Methods: A single-site retrospective case–control study from 2007 to 2016 in primary fragility hip fractures compared 665 patients who received an emergency department FNB to 326 patients who did not receive an FNB. The primary outcome was 1-year mortality. Secondary outcomes included mortality, mobility, and residence at discharge, 6 months, and 1-year intervals. Results: There were no significant differences in preoperative characteristics. Although there was no statistically significant difference in 1-year mortality, patients who did not receive an FNB were more likely to be nonambulant at 1 year (odds ratio 1.71, 95% confidence interval, 1.14-2.57, P = .005). There were no other significant differences in mobility, residence, or mortality. Conclusion: There was no statistically significant difference in 1-year mortality, although individuals who did not receive an FNB were more likely to be nonambulant at 1 year.

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