Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands

Rein Ketelaars, Joram T Stollman, Evelien van Eeten, Ties Eikendal, Jörgen Bruhn, Geert-Jan van Geffen, Rein Ketelaars, Joram T Stollman, Evelien van Eeten, Ties Eikendal, Jörgen Bruhn, Geert-Jan van Geffen

Abstract

Background: The treatment of acute pain in the emergency department is not always optimal. Peripheral nerve blocks using "blind" or nerve stimulator techniques have substantial disadvantages. Ultrasound-guided regional anesthesia may provide quick, safe, and effective pain relief in patients with proximal femoral fractures with severe pain. However, no evidence exists on emergency physician-performed ultrasound-guided regional anesthesia in these patients in Dutch emergency departments. We hypothesized that emergency physicians can be effectively trained to safely perform and implement ultrasound-guided femoral nerve blocks, resulting in effective pain relief in patients with proximal femoral fractures.

Methods: In this prospective observational study, emergency physicians were trained by expert anesthesiologists to perform ultrasound-guided femoral nerve blocks during a single-day course. Femoral nerve blocks were performed on patients with proximal femoral fractures. A system of direct supervision by skilled anesthesiologists and residents was put in place.

Results: A total of 64 femoral nerve blocks were performed. After 30 min, blocks were effective in 69% of patients, and after 60 min, in 83.3%. The mean reduction in pain scores after 30 and 60 min was 3.84 and 4.77, respectively (both p < 0.001). Patients reported a mean satisfaction of 8.42 (1 to 10 scale). No adverse events occurred.

Conclusions: Ultrasound-guided femoral nerve block is an effective, safe, and easy to learn (single-day course) procedure for emergency physicians to implement and perform in the emergency department. Patient satisfaction was high.

Conflict of interest statement

Ethics approval and consent to participate

This study was deemed exempt from formal review by the regional ethics review board of Arnhem and Nijmegen, and approval was obtained from the institutional review board of the Radboud university medical center. Before the ultrasound-guided femoral nerve block or FICB was performed, oral informed consent was obtained as part of the standard operating procedure.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Pain scores at baseline and after emergency department ultrasound-guided regional anesthesia in proximal femoral fractures. Pain scores at baseline and at 30, 60, and 120 min after an emergency physician-performed ultrasound-guided nerve block in emergency department patients with a proximal femoral fracture. 0 = absolutely no pain; 10 = most extreme pain. Boxes show median and interquartile range, whiskers mark the minimum and maximum (1.5 × lower and upper quartile), and dots are outliers. NRS numeric rating scale. *p <  0.001; **p <  0.001; ***p = 0.03

References

    1. Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain. 2007;8(6):460–466. doi: 10.1016/j.jpain.2006.12.005.
    1. Berben SA, Meijs TH, van Dongen RT, van Vugt AB, Vloet LC, Mintjes-de Groot JJ, et al. Pain prevalence and pain relief in trauma patients in the accident & emergency department. Injury. 2008;39(5):578–585. doi: 10.1016/j.injury.2007.04.013.
    1. Chesters A, Atkinson P. Fascia iliaca block for pain relief from proximal femoral fracture in the emergency department: a review of the literature. Emerg Med J. 2014;31(e1):e84–e87. doi: 10.1136/emermed-2013-203073.
    1. Mittal R, Vermani E. Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature. Emerg Med J. 2014;31(2):143–147. doi: 10.1136/emermed-2012-201546.
    1. Unneby A, Svensson O, Gustafson Y, Olofsson B. Femoral nerve block in a representative sample of elderly people with hip fracture: a randomised controlled trial. Injury. 2017;48(7):1542–1549. doi: 10.1016/j.injury.2017.04.043.
    1. Guay J, Parker MJ, Griffiths R, Kopp S. Peripheral nerve blocks for hip fractures. Cochrane Database Syst Rev. 2017;5:CD001159.
    1. Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010;28(1):76–81. doi: 10.1016/j.ajem.2008.09.015.
    1. Ritcey B, Pageau P, Woo MY, Perry JJ. Regional nerve blocks for hip and femoral neck fractures in the emergency department: a systematic review. CJEM. 2016;18(1):37–47. doi: 10.1017/cem.2015.75.
    1. Morrison RS, Magaziner J, Gilbert M, Koval KJ, McLaughlin MA, Orosz G, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003;58(1):76–81. doi: 10.1093/gerona/58.1.M76.
    1. Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthop Traumatol. 2009;10(3):127–133. doi: 10.1007/s10195-009-0062-6.
    1. Soeding PE, Sha S, Royse CE, Marks P, Hoy G, Royse AG. A randomized trial of ultrasound-guided brachial plexus anaesthesia in upper limb surgery. Anaesth Intensive Care. 2005;33(6):719–725.
    1. Liu SS. Evidence basis for ultrasound-guided block characteristics onset, quality, and duration. Reg Anesth Pain Med. 2016;41(2):205–220. doi: 10.1097/AAP.0000000000000141.
    1. Chin KJ, Chan V. Ultrasound-guided peripheral nerve blockade. Curr Opin Anaesthesiol. 2008;21(5):624–631. doi: 10.1097/ACO.0b013e32830815d1.
    1. Fuzier R, Tissot B, Mercier-Fuzier V, Barbero C, Caussade D, Mengelle F, et al. Evaluation of regional anesthesia procedure in an emergency department. Ann Fr Anesth Reanim. 2002;21(3):193–197. doi: 10.1016/S0750-7658(02)00585-3.
    1. Morrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, et al. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial. J Am Geriatr Soc. 2016;64(12):2433–2439. doi: 10.1111/jgs.14386.
    1. Amini R, Kartchner JZ, Nagdev A, Adhikari S. Ultrasound-guided nerve blocks in emergency medicine practice. J Ultrasound Med. 2016;35(4):731–736. doi: 10.7863/ultra.15.05095.
    1. Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20(6):584–591. doi: 10.1111/acem.12154.
    1. Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manag. 2003;25(5):406–411. doi: 10.1016/S0885-3924(03)00162-3.
    1. Groot L, Dijksman LM, Simons MP, Zwartsenburg MM, Rebel JR. Single fascia iliaca compartment block is safe and effective for emergency pain relief in hip-fracture patients. West J Emerg Med. 2015;16(7):1188–1193. doi: 10.5811/westjem.2015.10.28270.
    1. Dochez E, van Geffen GJ, Bruhn J, Hoogerwerf N, van de Pas H, Scheffer G. Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study. Scand J Trauma Resusc Emerg Med. 2014;22:38. doi: 10.1186/1757-7241-22-38.
    1. Gozlan C, Minville V, Asehnoune K, Raynal P, Zetlaoui P, Benhamou D. Fascia iliaca block for femoral bone fractures in prehospital medicine. Ann Fr Anesth Reanim. 2005;24(6):617–620. doi: 10.1016/j.annfar.2005.03.030.
    1. Haines L, Dickman E, Ayvazyan S, Pearl M, Wu S, Rosenblum D, et al. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. J Emerg Med. 2012;43(4):692–697. doi: 10.1016/j.jemermed.2012.01.050.
    1. Wu JJ, Lollo L, Grabinsky A. Regional anesthesia in trauma medicine. Anesthesiol Res Pract. 2011;2011:713281.
    1. van Geffen GJ, Bruhn J, Hoogerwerf N, Slagt C. The journey should start at home. Int Emerg Nurs. 2016;25:76. doi: 10.1016/j.ienj.2015.10.002.
    1. Riddell M, Ospina M, Holroyd-Leduc JM. Use of femoral nerve blocks to manage hip fracture pain among older adults in the emergency department: a systematic review. CJEM. 2016;18(4):245–252. doi: 10.1017/cem.2015.94.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere