BACKGROUND: Diaphyseal and distal femoral fractures are painful injuries that are frequently seen in patients requiring a trauma work-up in the hospital emergency department prior to definitive management. The purpose of this study was to determine whether a femoral nerve block administered in the emergency department could provide better pain relief for patients with femoral fractures than currently used pain management practices. METHODS:Patients who presented with an acute diaphyseal or distal femoral fracture were identified as potential candidates for this study. Eligible patients were randomized by medical record number to receive either (a) the femoral nerve block (20 mL of 0.5% bupivacaine) along with standard pain management or (b) standard pain management alone (typically intravenous narcotics). The pain was assessed with use of a visual analog scale at the initial evaluation and at five, fifteen, thirty, sixty, and ninety minutes following the initial evaluation. Fifty-four patients were enrolled in the study from April 2005 to May 2006. Thirty-one patients received a femoral nerve block, and twenty-three patients received standard pain management alone. RESULTS: Baseline scores on the visual analog pain scale did not differ between the groups at the initial evaluation. The patients who received a femoral nerve block (along with standard pain management) had significantly lower pain scores at five, fifteen, thirty, sixty, and ninety minutes following the block than did the patients who received standard pain management alone (p < 0.001). The score on the visual analog pain scale across these time-points was an average of 3.6 points less (on a 10-point scale) for those who received the block. There were no infections, paresthesias, or other complications related to the femoral nerve block. CONCLUSIONS: The acute pain of a diaphyseal or distal femoral fracture can be significantly decreased through the use of a femoral nerve block which can be administered safely in the hospital emergency department.
RCT Entities:
BACKGROUND: Diaphyseal and distal femoral fractures are painful injuries that are frequently seen in patients requiring a trauma work-up in the hospital emergency department prior to definitive management. The purpose of this study was to determine whether a femoral nerve block administered in the emergency department could provide better pain relief for patients with femoral fractures than currently used pain management practices. METHODS:Patients who presented with an acute diaphyseal or distal femoral fracture were identified as potential candidates for this study. Eligible patients were randomized by medical record number to receive either (a) the femoral nerve block (20 mL of 0.5% bupivacaine) along with standard pain management or (b) standard pain management alone (typically intravenous narcotics). The pain was assessed with use of a visual analog scale at the initial evaluation and at five, fifteen, thirty, sixty, and ninety minutes following the initial evaluation. Fifty-four patients were enrolled in the study from April 2005 to May 2006. Thirty-one patients received a femoral nerve block, and twenty-three patients received standard pain management alone. RESULTS: Baseline scores on the visual analog pain scale did not differ between the groups at the initial evaluation. The patients who received a femoral nerve block (along with standard pain management) had significantly lower pain scores at five, fifteen, thirty, sixty, and ninety minutes following the block than did the patients who received standard pain management alone (p < 0.001). The score on the visual analog pain scale across these time-points was an average of 3.6 points less (on a 10-point scale) for those who received the block. There were no infections, paresthesias, or other complications related to the femoral nerve block. CONCLUSIONS: The acute pain of a diaphyseal or distal femoral fracture can be significantly decreased through the use of a femoral nerve block which can be administered safely in the hospital emergency department.
Authors: Giorgio Veneziano; Jennifer Tripi; Dmitry Tumin; Mumin Hakim; David Martin; Ralph Beltran; Kevin Klingele; Tarun Bhalla; Joseph D Tobias Journal: J Pain Res Date: 2016-11-18 Impact factor: 3.133
Authors: Nicole M Elsey; Joseph D Tobias; Kevin E Klingele; Ralph J Beltran; Tarun Bhalla; David Martin; Giorgio Veneziano; Julie Rice; Dmitry Tumin Journal: J Pain Res Date: 2017-09-04 Impact factor: 3.133
Authors: Jacques Simon Lee; Tina Bhandari; Robert Simard; Marcel Emond; Claude Topping; Michael Woo; Jeffrey Perry; Debra Eagles; Andrew D McRae; Eddy Lang; Charles Wong; Marco Sivilotti; Joseph Newbigging; Bjug Borgundvaag; Shelley L McLeod; Donald Melady; Lan Chernoff; Alex Kiss; Jordan Chenkin Journal: BMJ Open Date: 2021-07-05 Impact factor: 2.692
Authors: Daniel J Cunningham; Ariana R Paniaugua; Micaela A LaRose; Isabel F DeLaura; Michael K Blatter; Mark J Gage Journal: Arch Orthop Trauma Surg Date: 2021-05-03 Impact factor: 2.928
Authors: Mario De Pinto; Armagan Dagal; Brendan O'Donnell; Agnes Stogicza; Sheila Chiu; William Thomas Edwards Journal: Int J Crit Illn Inj Sci Date: 2015 Jul-Sep