Introduction: Pain control is the most important issue in emergency department management of patients with femoral bone fractures. The present study aimed to compare the procedural features of ultrasonography and nerve stimulator guided femoral nerve block in this regard.
Method: In this randomized clinical trial, patients with proximal femoral fractures presenting to emergency department were randomly divided into two groups of ultrasonography or nerve stimulator guided femoral block and compared regarding success rate, procedural time, block time, and need for rescue doses of morphine sulfate, using SPSS 20.
Results: 50 patients were randomly divided into two groups of 25 (60% male). The mean age of studied patients was 35.14 ± 12.95 years (19 – 69). The two groups were similar regarding age (p= 0.788), sex (p = 0.564), and initial pain severity (p = 0.513). In 2 cases of nerve stimulator guided block, loss of pinprick sensation did not happen within 30 minutes of injection (success rate: 92%; p = 0.490). Ultrasonography guided nerve block cases had significantly lower procedural time (8.06 ± 1.92 vs 13.60 ± 4.56 minutes; p < 0.001) and lower need for rescue doses of opioid (2.68 ± 0.74 vs 5.28 ± 1.88 minutes; p < 0.001).
Conclusion: Ultrasonography and nerve stimulator guided femoral block had the same success rate and block duration. However, the ultrasonography guided group had lower procedure time and lower need for rescue doses of morphine sulfate. Therefore, ultrasonography guided femoral block could be considered as an available, safe, rapid, and efficient method for pain management of femoral fracture in emergency department.
Mutty CE, Jensen EJ, Manka MA, Anders MJ, Bone LB. Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department. J Bone Joint Surg Am. 2007;89(12):2599-603.
Christos SC, Chiampas G, Offman R, Rifenburg R. Ultrasound-guided three-in-one nerve block for femur fractures. Western Journal of Emergency Medicine. 2010;11(4).
Wathen JE, Gao D, Merritt G, Georgopoulos G, Battan FK. A randomized controlled trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department. Annals of emergency medicine. 2007;50(2):162-71. e1.
Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. The Cochrane Library. 2004.
Wu JJ, Lollo L, Grabinsky A. Regional anesthesia in trauma medicine. Anesthesiology research and practice. 2011;2011.
Lippert SC, Nagdev A, Stone MB, Herring A, Norris R. Pain control in disaster settings: a role for ultrasound-guided nerve blocks. Annals of emergency medicine. 2013;61(6):690-6.
Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65(s1):1-12.
Hunter TB, Peltier LF, Lund PJ. Radiologic History Exhibit: Musculoskeletal Eponyms: Who Are Those Guys? 1. Radiographics. 2000;20(3):819-36.
Casati A, Baciarello M, Di Cianni S, Danelli G, De Marco G, Leone S, et al. Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. British journal of anaesthesia. 2007;98(6):823-7.
Mittal R, Vermani E. Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature. Emergency Medicine Journal. 2013:emermed-2012-201546.
Alimohammadi H, Shojaee M, Samiei M, Abyari S, Vafaee A, Mirkheshti A. Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial. Emergency. 2013;1(1):4.
Alimohammadi H, Azizi M-R, Safari S, Amini A, Kariman H, Hatamabadi HR. Axillary nerve block in comparison with intravenous midazolam/fentanyl for painless reduction of upper extremity fractures. Acta Medica Iranica. 2014;52(2):122-4.
Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. The American journal of emergency medicine. 2010;28(1):76-81.
Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Annals of emergency medicine. 2003;41(2):227-33.
Kumar LCA, Sharma CD, Sibi ME, Datta CB, Gogoi LCB. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique. Indian journal of anaesthesia. 2014;58(6):700.
Cataldo R, Carassiti M, Costa F, Martuscelli M, Benedetto M, Cancilleri F, et al. Starting with ultrasonography decreases popliteal block performance time in inexperienced hands: a prospective randomized study. BMC anesthesiology. 2012;12(1):1.
Tran DQ, Dugani S, Finlayson RJ. A randomized comparison between ultrasound-guided and landmark-based superficial cervical plexus block. Regional anesthesia and pain medicine. 2010;35(6):539-43.
Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Regional anesthesia and pain medicine. 2008;33(3):259-65.
Rubin K, Sullivan D, Sadhasivam S. Are peripheral and neuraxial blocks with ultrasound guidance more effective and safe in children? Pediatric Anesthesia. 2009;19(2):92-6.
Choi S, Brull R. Is ultrasound guidance advantageous for interventional pain management? A review of acute pain outcomes. Anesthesia & Analgesia. 2011;113(3):596-604.
Oberndorfer U, Marhofer P, Bösenberg A, Willschke H, Felfernig M, Weintraud M, et al. Ultrasonographic guidance for sciatic and femoral nerve blocks in children†. British journal of anaesthesia. 2007;98(6):797-801.
Maalouf D, Liu SS, Movahedi R, Goytizolo E, Memstoudis SG, YaDeau JT, et al. Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery. Journal of clinical anesthesia. 2012;24(1):44-50.