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Regional nerve block in fractured neck of femur
  1. Bruce Martin, Specialist Registrar,
  2. Baha Ali, Senior Clinical Fellow
  1. K Mackway-Jones, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish whether regional nerve block is better than intravenous analgesia in reducing pain in hip fractures. Altogether 21 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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Report by Bruce Martin,Specialist Registrar
 Checked by Baha Ali, Senior Clinical Fellow

Clinical scenario

A 73 year old woman, who is usually fit and well, is brought to the emergency department after a fall. She is complaining of severe pain in her left groin. Examination shows that her left leg is shortened and externally rotated. You make a clinical diagnosis of fractured neck of femur (which is later confirmed radiologically). You wonder whether regional nerve block is better than intravenous analgesia for pain relief.

Three part question

In [patients with suspected neck of femur fracture] is [regional nerve block better than intravenous analgesia] at [providing and maintaining analgesia]?

Search strategy

Medline 1966–12/01 using the OVID interface. (exp femoral neck fractures OR exp hip fractures) AND (exp analgesia OR analgesia.mp) AND (exp nerve block OR nerve block.mp OR exp anesthesia, local OR exp anesthetics, local OR regional anaesthesia.mp OR regional anesthesia.mp).

Search outcome

Altogether 21 papers found. Of these only four were relevant to the preoperative setting (table 5).

Table 5

Comment(s)

The studies suggest some benefit for the use of nerve block in fractured neck of femur in the pre-operative setting, most notably in extracapsular fractures. However, the studies are small and have important weaknesses.

CLINICAL BOTTOM LINE

In patients with suspected fractured neck of femur, regional nerve block may be of benefit in reducing parenteral analgesic requirements.

Report by Bruce Martin,Specialist Registrar
 Checked by Baha Ali, Senior Clinical Fellow

References

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