Previous articleTable of Contents Next article

LETTER TO EDITOR
Year : 2010  |  Volume : 4  |  Issue : 2  |  Page : 118-119

Ultrasound guided femoral nerve block: An essential pain management modality in emergency settings for femur fractures


Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India

Correspondence Address:
Dheeraj Kapoor
1207, Sector 32 B, Chandigarh - 160 030
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.65127

Rights and Permissions
Date of Web Publication6-Jul-2010
 


How to cite this article:
Kapoor D, Palta S. Ultrasound guided femoral nerve block: An essential pain management modality in emergency settings for femur fractures. Saudi J Anaesth 2010;4:118-9

How to cite this URL:
Kapoor D, Palta S. Ultrasound guided femoral nerve block: An essential pain management modality in emergency settings for femur fractures. Saudi J Anaesth [serial online] 2010 [cited 2020 Feb 29];4:118-9. Available from: http://www.saudija.org/text.asp?2010/4/2/118/65127

Sir,

Femur fractures are excruciating injuries that are frequently seen in patients requiring a trauma workup in the emergency room (ER) prior to definitive surgical management. These injuries are extremely painful and merit prompt attention to adequate analgesia and are considered by many as a key management aim. [1]

Femoral nerve block (FNB) can significantly decrease the acute pain of a diaphyseal or distal femoral fracture and fracture neck of femur. This analgesic modality can be administered safely in the hospital emergency department and in the prehospital settings prior to the operative intervention. Profound analgesia is obtained without the adverse effects associated with systemic intravenous analgesics (i.e., respiratory depression, hemodynamic effects, or obtundation of consciousness). This block is also very successfully used to facilitate positioning for placement of neuraxial block in the operating room (OR). [2]

We in our institute routinely administer ultrasound (Sonosite; Titan with LHFL 38 high frequency 13-6 MHZ 38-mm linear array transducer) guided femoral nerve block prior to the operative intervention in femur fractures. We used out-of-plane needle insertion approach, by placing the insulated needle (5 cm, 22G) perpendicular to the transducer and ultrasound beam to inject local anesthetic (ropivacaine hydrochloride 0.75%) solution of mere 20 ml volume. We found that out-of-plane needle insertion approach is more convenient than the in-plane approach as the latter is more time consuming for alignment of needle with the ultrasound beam, which is often not possible in emergency situations. Moreover, if needed, catheter placement is easier with out-of-plane approach for prolonged analgesic requirements.

Conformation of the needle placement in peripheral nerve blocks is seen by many as a vital part of the procedure. In the emergency department, the use of a nerve stimulator for femoral nerve block would result in muscular contraction that would cause increased pain and would risk fracture displacement. Ultrasound guided FNB may be considered as a safe and an effective alternative to electrical nerve stimulation. Despite having a definitive advantage of clearly locating the nerves and negating the side effects caused by the nerve stimulator, the clarity of the image obtained can be obscured due to the presence of edema and subcutaneous air leading to block failure. [3]

Patients on emergency transport are prone to extreme stress reactions in painful conditions. Preclinically administered FNB can effectively decrease pain, anxiety and heart rate after femoral trauma. [4]

Ultrasound guided FNB can be used as an effective analgesic modality in patients with femur fractures thereby reducing post-traumatic stress disorder and the adverse effects of general anesthesia. This technique may decrease the onset time, improve the quality, reduce failure rate and permit a lower dose of local anesthetic. [5]

It is recommended that ultrasound guided FNB be considered as an important standard of care for femur fractures at emergency departments and in the OR prior to operative intervention. FNB can also be considered as an option for out-of-hospital analgesia for purposes of transportation and immobilization, provided it is administered by trained healthcare providers. [6]

 
  References Top

1.Scottish Intercollegiate Guidelines Network (SIGN). Prevention and management of hip fracture in older people. Edinburgh: SIGN; 2002 (SIGN publication no. 56). Available from: http://www.sign.ac.uk/guidelines/fulltext/56/index.html . [last cited on 2008 Aug 4].  Back to cited text no. 1      
2.Sia S, Pelusio F, Barbagli R, Rivituso C. Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: A comparison between femoral nerve block and intravenous fentanyl. Anesth Analg 2004;99:1221-4.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Saranteas T, Karakitsos D, Alevizou A, Poularas J, Kostopanagiotou G, Karabinis A. Limitations and technical considerations of ultrasound-guided peripheral nerve blocks: Edema and subcutaneous air. Reg Anesth Pain Med 2008;33:353-6.  Back to cited text no. 3  [PUBMED]    
4.Abbuhl FB, Reed DB. Time to analgesia for patients with painful extremity injuries transported to the emergency department by ambulance. Prehosp Emerg Care 2003;7:445-7.  Back to cited text no. 4  [PUBMED]    
5.Marhofer, Schrogendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3- in-1 blocks. Reg Anesth Pain Med 1998;23:584-8.   Back to cited text no. 5      
6.Chu RS, Browne GJ, Cheng NG, Lam LT. Femoral nerve block for femoral shaft fractures in a paediatric emergency department: Can it be done better? Eur J Emerg Med 2003;10:258-63.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  




 

Top
 
Previous article Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  IN THIS Article
   References

 Article Access Statistics
    Viewed2711    
    Printed86    
    Emailed1    
    PDF Downloaded185    
    Comments [Add]    

Recommend this journal