Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.08.017
Brazilian Journal of Anesthesiology
Review Article

Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review

Bloqueio do nervo femoral versus fentanil por via venosa em pacientes adultos com fraturas de quadril - revisão sistemática

Flávia Vieira Guimarães Hartmann; Maria Rita Carvalho Garbi Novaes; Marta Rodrigues de Carvalho

Downloads: 0
Views: 647

Abstract

Abstract Background: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5 cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. Objective: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. Methods: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Results: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. Conclusion: The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.

Keywords

Hip fractures, Femoral nerve block, Analgesia, Fentanyl

Resumo

Resumo Justificativa: As fraturas de quadril são uma questão importante de saúde pública e estão associadas a altas taxas de mortalidade e perda de funcionalidade. As fraturas de quadril referem-se a uma fratura que ocorre entre a borda da cabeça femoral e 5cm abaixo do trocanter menor e são comuns em emergências ortopédicas. O número de fraturas do fêmur proximal provavelmente aumentará à medida que a população envelhece. O custo médio da assistência médica durante a hospitalização inicial para fratura de quadril pode ser estimado em US$ 7.000 por paciente. As fraturas do fêmur são dolorosas e requerem analgesia adequada imediata. O tratamento da dor causada por fraturas de fêmur é difícil porque há um número limitado de analgésicos disponíveis, muitos dos quais têm efeitos colaterais que podem limitar o seu uso. Os opioides são os fármacos mais usados, mas podem trazer algumas complicações. Nesse contexto, os bloqueios do nervo femoral podem ser uma opção segura. É uma técnica de anestesia regional específica usada em medicina de emergência para proporcionar anestesia e analgesia do membro afetado. Objetivo: Comparar a eficácia analgésica de fentanil versus bloqueio do nervo femoral antes do posicionamento para fazer raquianestesia em pacientes com fratura de fêmur avaliados com escalas de dor. Métodos: Revisão sistemática da literatura científica. Estudos descritos como ensaios clínicos randomizados que comparam bloqueio do nervo femoral e fentanil tradicional foram incluídos. Dois autores da revisão (MR e FH) avaliaram de forma independente os estudos potencialmente elegíveis para inclusão. A metodologia da avaliação baseou-se na ferramenta desenvolvida pela Colaboração Cochrane para avaliação de viés dos ensaios clínicos randomizados. As bases de dados Biblioteca Cochrane, PubMed, Medline e Lilacs foram consultadas para todos os artigos publicados, sem restrições de língua ou de tempo. Resultados: Dois estudos foram incluídos nesta revisão. O bloqueio do nervo pareceu ser mais eficaz do que fentanil por via intravenosa para a prevenção da dor em pacientes com fratura femoral. Também reduziu o uso de analgesia adicional e diminuiu o risco de complicações sistêmicas. O bloqueio femoral reduziu o tempo de administração da raquianestesia ao paciente a ser submetido à cirurgia e facilitou a posição sentada para esse fim. Conclusão: O uso de bloqueio do nervo femoral pode reduzir o nível de dor e a necessidade de analgesia adicional. Há menos eventos adversos sistêmicos associados a esse procedimento, que não oferece maiores riscos. Mais estudos são necessários para conclusões adicionais.

Palavras-chave

Fraturas de quadril, Bloqueio do nervo femoral, Analgesia, Fentanil

References

Layzell MJ. Use of femoral nerve blocks in adults with hip fractures. Nurs Stand. 2013;27:49-56.

Watson MJ, Walker E, Rowell S. Femoral nerve block for pain relief in hip fracture: a dose finding study. Anaesthesia. 2014;69:683-6.

Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761-7.

White SM, Griffiths R. Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury. 2011;42:1230-3.

Melton 3 LJ, Cooper C. Magnitude and impact of osteoporosis and fractures. Osteoporosis. 2001;1:557-67.

Johnell O. The socioeconomic burden of fractures: today and in the 21st century. Am J Med. 1997;103:20S-5S.

Praemer A, Furner S, Rice DP. Musculoskeletal conditions in the United States. 1992.

Vidal EIO. Capítulo 2:Clinical profile of elderly Brazilians with hip fracture: comorbidities, treatment, patterns, complications and mortality. Aspectos epidemiológicos das fraturas do fêmur proximal em idosos. 2010:61-76.

Johnell O, Kanis J. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. 2004;15:897-902.

Maxwell L, White S. Anaesthetic management of patients with hip fractures: an update. Cont Educ Anaesth Crit Care Pain. 2013;13:179-83.

Tam CW, Rainer TH. Femoral nerve block for pain management of femoral fractures in the emergency department: evidence based topic review. Hong Kong J Emerg Med. 2013;12:178-81.

Haines L, Dickman E, Ayvazyan S. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. J Emerg Med. 2012;43:692-7.

Parker MJ, Griffiths R, Appadu B. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures (review). Cochrane Database Syst Rev. 2002;1:CD001159.

Bogacz A, Jamison M. Femoral nerve block - a guide for medical students and junior doctors. Scot Univ Med J. 2012:185-91.

Relação nacional de medicamentos essenciais: Rename/Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Assistência Farmacêutica e Insumos Estratégicos. 2010.

Peng PW, Sandler AN. A review of the use of fentanyl analgesia in the management of acute pain in adults. Anesthesiology. 1999;90:576-99.

Sia S, Pelusio F, Barbagli R. Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl. Anesth Analg.. 2004;99:1221-4.

Iamaroon A, Raksakietisak M, Halilamien P. Femoral nerve block versus fentanyl: analgesia for positioning patients with fractured femur. Local Reg Anesth.. 2010;3:21-6.

Abou-Setta AM, Beaupre LA, Rashiq S. Comparative effectiveness of pain management interventions for hip fracture: a systematic review. Ann Intern Med. 2011;155:234-45.

Ginosar Y, Riley ET, Angst MS. The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Anesth Analg. 2003;97:1428-38.

Vardanyan RS, Hruby VJ. Fentanyl-related compounds and derivatives: current status and future prospects for pharmaceutical applications. Future Med Chem. 2014;6:385-412.

Glass PSA, Shafer SL, Jacobs JR. Intravenous drug delivery systems. Anesthesia. 1994:389-416.

Berry FR. Analgesia in patients with fractured shaft of femur. Anaesthesia. 1977;32:576-7.

Mittal R, Vermani E. Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature. Emerg Med J. 2014;31:143-7.

Pennington N, Gadd RJ, Green N. A national survey of acute hospitals in England on their current practice in the use of femoral nerve blocks when splinting femoral fractures. Injury. 2012;43:843-5.

Black KJL, Bevan CA, Murphy NG. Nerve blocks for initial pain management of femoral fractures in children (review). Cochrane Database Syst Rev. 2013;17:CD009587.

McGlone R, Sadhra K, Hamer DW. Femoral nerve block in the initial management of femoral shaft fractures. Arch Emerg Med. 1987;4:163-8.

Barriot P, Riou B, Ronchi L. Femoral nerve block in prehospital care management of fractured shaft of femur. JEUR. 1988;1:21-4.

5dcd9fa00e88251e72bf58f1 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections