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Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

  • Madison Riddell (a1), Maria Ospina (a2) and Jayna M. Holroyd-Leduc (a1) (a2) (a3)

Abstract

Objective

Hip fractures are a common source of acute pain amongst the frail elderly. One potential technique to adequately manage pain in this population is the femoral nerve block. The objective of this systematic review was to provide updated evidence for the use of femoral nerve blocks as a pain management technique for older hip fracture patients in the emergency department (ED).

Data Sources

Searches of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were conducted between December 2010 and May 2014. The reference list of a previous systematic review was also searched.

Study Selection

We included randomized control trials examining the use of femoral nerve blocks in the ED among older adults (65 years of age or older) with acute hip fracture.

Data Extraction

Among 93 citations reviewed, seven trials were included. Four studies employed a single femoral nerve block, while three studies employed continuous (catheter-placed) femoral blocks. All but one of the studies were found to have a high risk of bias.

Data Synthesis

All studies reported reductions in pain intensity with femoral nerve blocks. All but one study reported decreased rescue analgesia requirements. There were no adverse effects found to be associated with the femoral block procedure; rather, two studies found a decreased risk of adverse events such as respiratory and cardiac complications.

Conclusions

Femoral nerve blocks appear to have benefits both in terms of decreasing the pain experienced by older patients, as well as limiting the amount of systemic opioids administered to this population.

Objectif

Les fractures de la hanche sont une cause fréquente de douleur aiguë chez les personnes âgées fragiles. L’un des moyens possibles de soulager efficacement la douleur dans ce groupe de personnes est le bloc fémoral. La revue systématique visait à recueillir des données probantes à jour sur le bloc fémoral comme moyen de soulagement de la douleur causée par les fractures de la hanche, chez les personnes âgées, au service des urgences (SU).

Sources de données

Des recherches ont été menées dans les bases de données Medline, EMBASE et Cochrane Central Register of Controlled Trials, entre décembre 2010 et mai 2014. La liste de références bibliographiques d’une revue systématique antérieure a aussi fait l’objet de recherches.

Sélection des études

Ont été sélectionnés des essais comparatifs, à répartition aléatoire, de blocs fémoraux, au SU, chez des personnes âgées (65 ans et plus) traitées pour une fracture de la hanche.

Extraction des données

Après l’examen de 93 citations, 7 essais ont été retenus. Dans quatre d’entre eux, on avait effectué un seul bloc fémoral, tandis que dans les trois autres on avait effectué un bloc fémoral continu (à l’aide d’un cathéter). Toutes les études, à l’exception d’une seule, comportaient un risque élevé de biais.

Synthèse des données

Dans toutes les études, les auteurs ont fait état d’une diminution de l’intensité de la douleur produite par les blocs fémoraux et, sauf dans une, d’une diminution des besoins d’analgésie d’appoint. Aucun effet indésirable n’a été associé au bloc fémoral; au contraire, les auteurs ont même constaté, dans deux études, une diminution du risque d’événement indésirable tel que des complications cardiaques ou respiratoires.

Conclusions

Les blocs fémoraux semblent avantageux tant sur le plan du soulagement de la douleur chez les personnes âgées que sur celui de l’administration d’opioïdes à action générale, dans ce segment de la population.

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Copyright

Corresponding author

Correspondence to: Dr. Jayna M. Holroyd-Leduc, Foothills Hospital, 11th Floor South Tower Room 1103, 1403-29 Street NW, Calgary, Alberta, T2N 2T9; Email: Jayna.holroyd-leduc@albertahealthservices.ca

References

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Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

  • Madison Riddell (a1), Maria Ospina (a2) and Jayna M. Holroyd-Leduc (a1) (a2) (a3)

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