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Efficacy of fascia iliaca nerve block in daily routine for children with femoral fractures in a pediatric emergency department. Arch Pediatr 2021; 28:544-547. [PMID: 34593294 DOI: 10.1016/j.arcped.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 04/13/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy of fascia iliaca nerve block (FINB), routinely used for children with femoral fractures, in a pediatric emergency department (PED). METHODS This retrospective, single-center, observational study examined FINB using ropivacaine and a 1% lidocaine hydrochloride solution, in all patients under 18 years of age admitted with a femoral fracture from January 2012 to December 2016. Pain was assessed using two validated pediatric pain scales: EVENDOL or a visual analog scale. A level of ≥ 4 on either scale indicates the need for an analgesic. The primary outcome was the percentage of patients who were pain free after the FINB procedure defined by a pain score of < 4. Secondary outcomes were the time spent between PED admission and FINB, the need of additional analgesics, side effects, and the success rate of FINB. RESULTS Of 161 patients screened, 144 were included. The median age was 3.2 years (range 2 months to 16 years) and 74% were boys. The number of children determined to be pain free (pain score < 4) increased from 36 (25%) before the FINB to 123 (85%) after the FINB (absolute risk difference 60%, 95% CI: 51%-70%). Overall, 21 children (15%) required a second analgesic after the FINB. CONCLUSION The routine use of FINB with ropivacaine and lidocaine by pediatric ED physicians provided effective pain relief for children admitted for a femoral fracture in the emergency department. Our data support the efficiency and feasibility of FINB for the antalgic management of children with femoral fracture.
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Topal FE, Bilgin S, Yamanoglu A, Karakaya Z, Payza U, Akyol PY, Aslan C, Aksun M. The Feasibility of the Ultrasound-Guided Femoral Nerve Block Procedure with Low-Dose Local Anesthetic in Intracapsular and Extracapsular Hip Fractures. J Emerg Med 2020; 58:553-561. [PMID: 32070647 DOI: 10.1016/j.jemermed.2019.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/25/2019] [Accepted: 12/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management. OBJECTIVES The aim of this study was to determine the success of lower local anesthetic dosages capable of reducing costs and excessive exposure to drugs in pain control in patients with femoral neck fractures (FNFs) in the ED. METHODS Patients ≥65 years of age with FNFs and reporting Wong-Baker Pain Rating Scales scores ≥8 were included in this prospective, interventional study. Patients underwent ultrasound-guided regional femoral block with 5 mL 2% prilocaine. Pain scores before the procedure and at 30 min and 2 h postprocedure were compared with the Friedman test and Wilcoxon test with Bonferroni correction. RESULTS Forty patients, 20 with intracapsular and 20 with extracapsular FNFs, were enrolled. The initial pain scores of patients with both intra- and extracapsular fractures were 8 (range 8-10). A statistically significant 50% decrease in pain scores was observed in both groups 30 min after the regional block procedure (p < 0.001). A statistically significant 75% decrease in pain scores was observed in both groups 2 h after the regional block procedure (p < 0.001). No statistically significant difference was determined in the change in 30-min and 2-h pain scores between the groups. CONCLUSIONS The administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures.
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Affiliation(s)
- Fatih Esad Topal
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serkan Bilgin
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Adnan Yamanoglu
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Zeynep Karakaya
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Umut Payza
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Pınar Yesim Akyol
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Cihan Aslan
- Department of Orthopaedics and Traumatology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Murat Aksun
- Department of Anesthesiology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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Scurrah A, Shiner CT, Stevens JA, Faux SG. Regional nerve blockade for early analgesic management of elderly patients with hip fracture - a narrative review. Anaesthesia 2017; 73:769-783. [DOI: 10.1111/anae.14178] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/27/2022]
Affiliation(s)
- A. Scurrah
- Department of Anaesthetics; St Vincent's Hospital Sydney; NSW Australia
| | - C. T. Shiner
- Department of Rehabilitation and Pain Medicine; St Vincent's Hospital Sydney; NSW Australia
| | - J. A. Stevens
- Department of Anaesthetics; St Vincent's Hospital Sydney; NSW Australia
| | - S. G. Faux
- Department of Rehabilitation and Pain Medicine; St Vincent's Hospital Sydney; NSW Australia
- University of New South Wales; Sydney NSW Australia
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Hartmann FVG, Novaes MRCG, Carvalho MRD. [Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review]. Rev Bras Anestesiol 2016; 67:67-71. [PMID: 27838114 DOI: 10.1016/j.bjan.2016.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/25/2015] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. OBJECTIVE To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. METHODS A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. RESULTS Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. CONCLUSION The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.
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Affiliation(s)
- Flávia Vieira Guimarães Hartmann
- Hospital de Base do Distrito Federal, Brasília, DF, Brasil; Hospital Militar de Área de Brasília, Brasília, DF, Brasil; Fundacão de Ensino e Pesquisa em Ciências da Saúde, Brasília, DF, Brasil; Escola Superior de Ciências da Saúde, Brasília, DF, Brasil.
| | - Maria Rita Carvalho Garbi Novaes
- Farmácia Hospitalar, Departamento de Saúde, Brasília, DF, Brasil; Universidad del Chile, Santiago, Chile; Fundação de Ensino e Pesquisa em Ciências da Saúde, Escola Superior de Ciências da Saúde, Brasília, DF, Brasil
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Hartmann FVG, Novaes MRCG, de Carvalho MR. Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review. Braz J Anesthesiol 2016; 67:67-71. [PMID: 28017173 DOI: 10.1016/j.bjane.2015.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/25/2015] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. OBJECTIVE To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. METHODS A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. RESULTS Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. CONCLUSION The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.
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Affiliation(s)
- Flávia Vieira Guimarães Hartmann
- Hospital de Base do Distrito Federal, Brasília, DF, Brazil; Hospital Militar de Área de Brasília, Brasília, DF, Brazil; Fundacão de Ensino e Pesquisa em Ciências da Saúde, Brasília, DF, Brazil; Escola Superior de Ciências da Saúde, Brasília, DF, Brazil.
| | - Maria Rita Carvalho Garbi Novaes
- Farmácia Hospitalar, Departamento de Saúde, Brasília, DF, Brazil; Universidad del Chile, Santiago, Chile; Fundação de Ensino e Pesquisa em Ciências da Saúde, Escola Superior de Ciências da Saúde, Brasília, DF, Brazil
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Watson MJ, Walker E, Halliday S, Binning A, Rowell S, Lumsden MA, Higgins M, McConnachie A. Duration of analgesia for hip fracture using an ED95 dose of levobupivacaine. Anaesthesia 2015; 70:1218-9. [PMID: 26372877 DOI: 10.1111/anae.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M J Watson
- South Glasgow University Hospital, Glasgow, UK.
| | - E Walker
- South Glasgow University Hospital, Glasgow, UK
| | - S Halliday
- South Glasgow University Hospital, Glasgow, UK
| | - A Binning
- South Glasgow University Hospital, Glasgow, UK
| | - S Rowell
- Joondalup Health Campus, Perth, Australia
| | | | - M Higgins
- Golden Jubilee National Hospital, Glasgow, UK
| | - A McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Gadsden J, Warlick A. Regional anesthesia for the trauma patient: improving patient outcomes. Local Reg Anesth 2015; 8:45-55. [PMID: 26316813 PMCID: PMC4540140 DOI: 10.2147/lra.s55322] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile.
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Affiliation(s)
- Jeff Gadsden
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Alicia Warlick
- Department of Anesthesiology, Duke University, Durham, NC, USA
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Tidman V, Bick E. Femoral nerve block dose after hip fracture. Anaesthesia 2015; 69:1403-4. [PMID: 25394703 DOI: 10.1111/anae.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- V Tidman
- Royal Ear, Nose and Throat Hospital, London, UK.
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A Randomized Study to Compare the Analgesic Efficacy of Ultrasound-Guided Block of Fascia Iliaca Compartment or Femoral Nerve After Patella Fracture Surgery. Cell Biochem Biophys 2015; 72:567-70. [DOI: 10.1007/s12013-014-0503-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Watson MJ. A reply. Anaesthesia 2014; 69:1404-5. [PMID: 25394705 DOI: 10.1111/anae.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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O'Donnell BD, Szűcs S. Peripheral nerve block and local anaesthetic dose, how much is enough? Anaesthesia 2014; 69:665-8. [DOI: 10.1111/anae.12629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. D. O'Donnell
- Department of Anaesthesia; Cork University Hospital and University College Cork; Cork Ireland
| | - S. Szűcs
- Department of Anaesthesia; Mercy University Hospital; Cork Ireland
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