Table 5
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Finlayson BJ and Underhill TJ, 1988, UK36 patients age range 31–95 with fractured neck of femur. Intracapsular (16) and extracapsular (20)Cohort studyObjective Assessment Subjective Assessment Complications29 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 foundHeterogenous group of patients (2 young patients, 1 with multiple injuries)
Haddad FS and Williams RL, 1995, UK50 patients with extracapsular fractures of the femoral neck, age range 68–89RCTMean pain score using VAS Analgesic requirements Incidence of complicationsGreater reduction in nerve block group— statistically significant at 15 min and 2 hoursSmall number of patients. Only extracapsular fractures included.
Femoral nerve block (0.3 ml/kg 0.25% bupivicaine) v systemic analgesia aloneReduced in the 24 hours from admission in nerve block group Significantly reduced in nerve block group? Optimal analgesia given to control group
Chudinov A et al, 1999, Israel40 consecutive patients age 67–96 years with fractured neck of femur undergoing surgery.RCTPain relief (VAS) Complication RateSignificant difference in psoas block group at 8 and 16 hours preoperatively and 16, 24, and 32 hours postoperativelyMethod of randomisation unclear.
 Small numbers of patients.
Continuous psoas compartment block (2 mg/kg/ of 0.25% bupivocaine with 0.8 ml/kg adrenaline) v analgesia3 cases of local erythema in psoas groupUnclear whether optimal analgesia given to control group. Type of block not typically used in emergency setting
Parker MJ et al, 2000, UK269 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 analgesiaSystematic reviewPain levels Analgesic Requirements Complication rateReduction in mean pain score in nerve block groupHeterogenous group of patients Trials involving both preoperative and postoperative patients were assessed together
Reduced analgesic requirements in nerve block group No differenceDifferent forms of block used in different trials Small numbers in contributing studies Unclear if amount of parenteral analgesia given was optimal