Femoral nerve blockade administered preclinically for pain relief in severe knee trauma is more feasible and effective than intravenous metamizole: a randomized controlled trial.
BACKGROUND
Before clinical treatment and during transportation, the analgesic therapy offered to patients with painful knee trauma may be quite insufficient. We hypothesize that a femoral nerve blockade for analgesia can be administered in a preclinical setting at the injury site and provides better pain relief than intravenous metamizole, whose analgesic effect is comparable with that of opioids.


METHODS
After an initial clinical investigation, 52 patients were randomized according to computer-generated codes; 26 patients received a femoral nerve blockade and 26 received metamizole. The treatment was started at the injury site and the level of pain on the 100-mm visual analog scale was assessed at the beginning and the end of treatment.


RESULTS
Pain and anxiety scores were significantly reduced by half in the femoral nerve blockade group; peripheral vasoconstriction was noted in 26 patients at the injury site and dropped to six at the time of arrival at the hospital. Two of 26 patients in the blockade group did not benefit from the treatment. In the metamizole group, pain and anxiety did not decrease significantly; vasoconstriction persisted in all patients.


CONCLUSIONS
Patients with painful knee trauma benefited from femoral nerve blockade administered before hospitalization. The treatment can be administered safely in the preclinical setting and provides effective analgesia.
Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria. renate.barker@meduniwien.ac.at
Renate
R
Barker
Arno
A
Schiferer
Carmen
C
Gore
Laszlo
L
Gorove
Thomas
T
Lang
Barbara
B
Steinlechner
Kassem Abou
KA
Roumieh
Michael
M
Zimpfer
Alexander
A
Kober
D000328:Adult; D000704:Analysis of Variance; D004177:Dipyrone / Q000008:administration & dosage*; D005260:Female; D005267:Femoral Nerve; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D015601:Injury Severity Score; D007718:Knee Injuries / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement / Q000187:drug effects*; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D016896:Treatment Outcome
D004177:Dipyrone