title: Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature.
abstract: Fractures of the femur are common orthopaedic emergencies presenting to emergency departments (ED). Femoral nerve block (FNB) is a fast, safe and effective means of providing pain relief to these patients. With the aim to analysing the variation in current practice of giving FNB in patients with fractured femur in the UK, we carried out a telephonic national survey. Out of 252 EDs contacted, 230 departments participated in the survey (91% response rate). The survey showed that 74% EDs in the UK had access to ultrasound, but only 10% EDs gave FNB regularly under ultrasound guidance. In total, 46% of EDs gave FNB by blind technique. Therefore, ultrasound-guided FNB is an underutilised method of providing pain relief for fractured femur patients. The main reasons for not using ultrasound for FNB were: lack of training, participants' confidence in giving an effective and safe FNB block blindly and time constraints. The literature review suggests that ultrasound-guided FNB has a faster onset of action, is more effective and safer than the FNB given with nerve stimulator (NS) or blindly, and probably needs lower local anaesthetic dose. The use of NS for FNB in ED might not be practical because of the likelihood of the pain resulting from the movement of the affected limb due to the contraction of the muscles caused by nerve stimulation and because of additional training needed in using NS. The studies comparing FNB given using ultrasound or NS, or given blindly, have been done in the perioperative settings. To date, there has been no randomised controlled trial in ED setting comparing FNB given blindly or under ultrasound guidance. Such a study might have provided a good evidence for modifying the current practice of blind FNB.
authors: Department of Emergency Medicine, Countess of Chester Hospital, NHS Foundation Trust, , Chester, Cheshire, UK.
authors: Rajnish
authors: R
authors: Mittal
authors: Era
authors: E
authors: Vermani
mesh_terms: D000698:Analgesia / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D004636:Emergency Service, Hospital; D005264:Femoral Fractures / Q000150:complications*; D005267:Femoral Nerve / Q000000981:diagnostic imaging; D019983:Guideline Adherence; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D010818:Practice Patterns, Physicians'; D014463:Ultrasonography; D006113:United Kingdom
chemical_list: D000701:Analgesics, Opioid
keywords: analgesia/pain control; musculo-skeletal; ultrasound