| Finlayson BJ and Underhill TJ, 1988, UK | 36 patients age range 31–95 with fractured neck of femur. Intracapsular (16) and extracapsular (20) | Cohort study | Objective Assessment Subjective Assessment Complications | 29 had reduced sensation. 7 no change (6 intracapsular, 1 extracapsular) | No control group Statistical significance not assessed |
| Femoral nerve block (10 ml 0.5% bupivocaine) | | | 26 patients had reduced pain (14 intracapsular, 12 extracapsular), 4 had no pain (all extracapsular), 6 had no change (all intracapsular) None found | Heterogenous group of patients (2 young patients, 1 with multiple injuries) |
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| Haddad FS and Williams RL, 1995, UK | 50 patients with extracapsular fractures of the femoral neck, age range 68–89 | RCT | Mean pain score using VAS Analgesic requirements Incidence of complications | Greater reduction in nerve block group— statistically significant at 15 min and 2 hours | Small number of patients. Only extracapsular fractures included. |
| Femoral nerve block (0.3 ml/kg 0.25% bupivicaine) v systemic analgesia alone | | | Reduced in the 24 hours from admission in nerve block group Significantly reduced in nerve block group | ? Optimal analgesia given to control group |
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| Chudinov A et al, 1999, Israel | 40 consecutive patients age 67–96 years with fractured neck of femur undergoing surgery. | RCT | Pain relief (VAS) Complication Rate | Significant difference in psoas block group at 8 and 16 hours preoperatively and 16, 24, and 32 hours postoperatively | Method of randomisation unclear.
Small numbers of patients.
Unblinded. |
| Continuous psoas compartment block (2 mg/kg/ of 0.25% bupivocaine with 0.8 ml/kg adrenaline) v analgesia | | | 3 cases of local erythema in psoas group | Unclear whether optimal analgesia given to control group. Type of block not typically used in emergency setting |
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| Parker MJ et al, 2000, UK | 269 patients from 7 randomised or quasi-randomised trials with fractured neck of femur— analgesia/anaesthesia given preoperatively in 2 of these trials. Patients given either regional block or intravenous analgesia | Systematic review | Pain levels Analgesic Requirements Complication rate | Reduction in mean pain score in nerve block group | Heterogenous group of patients Trials involving both preoperative and postoperative patients were assessed together |
| | | | Reduced analgesic requirements in nerve block group No difference | Different forms of block used in different trials Small numbers in contributing studies Unclear if amount of parenteral analgesia given was optimal |