title: Femoral nerve blocks for fractured neck of femur patients: A 'feel good solution' but a 'short-term fix'?
abstract: OBJECTIVE
  Femoral nerve blocks (FNBs) are commonly administered to patients with a fractured neck of femur (NOF). FNBs reduce complications associated with opioids and are effective for up to 24 h. However, the recognised 'gold standard' time to definitive treatment (surgery) in the patient with a fractured NOF is within 48 h. This leaves a significant period of time in which the patient has no effective analgesia, and might require opioids to alleviate pain. The present study explored the number of NOF patients who received a FNB: their wait for definitive treatment (surgery) and how much opioid analgesia was administered in the preoperative phase.
  
  
  METHODS
  A retrospective review of electronic patient records was conducted over a 6 month period in 2012. Patients who presented to the ED with a fractured NOF, received a FNB and were transferred to surgery in the same hospital were included in the sample.
  
  
  RESULTS
  The median time from FNBs to surgery was 37.5 h. When patients waited more than 20 h for surgery, the volume of opioid received increased significantly (P ≤ 0.001).
  
  
  CONCLUSIONS
  Even when patients' time to surgery was within the 'gold standard', patients received increasing doses of opioids 20 h after the administration of the FNB. While patients continue to wait extended periods for surgery, the practice of administering a single injection FNB needs to be challenged. ED clinicians might consider FNB infusions rather than single injection FNBs for patients with a fractured NOF.
authors.affiliation: Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Clothier
authors.affiliation: Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.|School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Morphet
keywords: 3-in-1 block; emergency department; fascia iliaca block; femoral nerve block; fractured neck of femur