Paul J McRae1, Jason C Bendall2, Veronica Madigan1, Paul M Middleton3. 1. NSW Ambulance, Rozelle, New South Wales, Australia; School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia. 2. NSW Ambulance, Rozelle, New South Wales, Australia; School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia; Department of Anaesthesia, Gosford Hospital, Gosford, New South Wales, Australia. 3. School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia; Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. These injuries are painful, and the need for extrication and transport adds complexity to the management of this condition. Whereas traditional analgesia involves parenteral opioids, regional nerve blockade for femoral fractures have been demonstrated to be effective when performed by physicians. Regional peripheral nerve blockade performed by paramedics may be suitable in the prehospital setting. STUDY OBJECTIVES: To examine the efficacy and feasibility of paramedic-performed fascia iliaca compartment block (FICB) for patients with suspected hip or femur fractures in the prehospital setting compared to intravenous morphine alone. METHODS: Prior to treatment allocation, all patients received a loading dose of morphine intravenously, then received either 1) FICB using lidocaine with epinephrine; or 2) standard care (further intravenous morphine only) in this nonblinded, randomized control trial. Participants rated their pain using a standard 11-point verbal numerical rating scale prior to and 15 min after receiving the allocated treatment. Secondary outcomes included effectiveness at other time points and incidence of adverse effects. RESULTS: We analyzed 11 and 13 patients in the FICB and standard care groups, respectively. Patients treated with FICB had a greater reduction in their median pain score than patients in the standard care group (50% vs. 22%, p = 0.025) after 15 min. In the FICB group, median pain scores decreased by 5 (interquartile range 4-6), compared to 2 (interquartile range 0-4) in the standard care group. The FICB procedure did not significantly impact on scene times. No immediately obvious adverse events were noted in the 11 participants who received FICB from paramedics. CONCLUSION: The study suggests that FICB can be performed by trained paramedics for patients with suspected femoral fractures.
RCT Entities:
BACKGROUND: Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. These injuries are painful, and the need for extrication and transport adds complexity to the management of this condition. Whereas traditional analgesia involves parenteral opioids, regional nerve blockade for femoral fractures have been demonstrated to be effective when performed by physicians. Regional peripheral nerve blockade performed by paramedics may be suitable in the prehospital setting. STUDY OBJECTIVES: To examine the efficacy and feasibility of paramedic-performed fascia iliaca compartment block (FICB) for patients with suspected hip or femur fractures in the prehospital setting compared to intravenous morphine alone. METHODS: Prior to treatment allocation, all patients received a loading dose of morphine intravenously, then received either 1) FICB using lidocaine with epinephrine; or 2) standard care (further intravenous morphine only) in this nonblinded, randomized control trial. Participants rated their pain using a standard 11-point verbal numerical rating scale prior to and 15 min after receiving the allocated treatment. Secondary outcomes included effectiveness at other time points and incidence of adverse effects. RESULTS: We analyzed 11 and 13 patients in the FICB and standard care groups, respectively. Patients treated with FICB had a greater reduction in their median pain score than patients in the standard care group (50% vs. 22%, p = 0.025) after 15 min. In the FICB group, median pain scores decreased by 5 (interquartile range 4-6), compared to 2 (interquartile range 0-4) in the standard care group. The FICB procedure did not significantly impact on scene times. No immediately obvious adverse events were noted in the 11 participants who received FICB from paramedics. CONCLUSION: The study suggests that FICB can be performed by trained paramedics for patients with suspected femoral fractures.
Authors: Jenna K Bulger; Alan Brown; Bridie A Evans; Greg Fegan; Simon Ford; Katy Guy; Sian Jones; Leigh Keen; Ashrafunnesa Khanom; Ian Pallister; Nigel Rees; Ian T Russell; Anne C Seagrove; Helen A Snooks Journal: Pilot Feasibility Stud Date: 2017-01-23
Authors: Kristian D Friesgaard; Erika F Christensen; Hans Kirkegaard; Mette D Bendtsen; Flemming B Jensen; Lone Nikolajsen Journal: Scand J Trauma Resusc Emerg Med Date: 2017-01-19 Impact factor: 2.953