Femoral nerve blocks for the treatment of acute prehospital pain: a systematic reviewwith meta-analysis

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DOI

  • Lasse Raatiniemi, Anaesthesia Research group, MRC, Oulu University Hospital and University of Oulu, Oulu, Finland.
  • ,
  • Vidar Magnusson, Prehospital section and Department of Anaesthesia, Landspitalinn University Hospital, Reykjavik, Iceland.
  • ,
  • Per Kristian Hyldmo, Trauma Unit, Sørlandet Hospital, Kristiansand, Norway.
  • ,
  • Kristian Dahl Friesgaard
  • Poul Kongstad, Department of Prehospital Care and Disaster Medicine, Region of Skåne, Lund, Sweden.
  • ,
  • Jouni Kurola, Centre for Prehospital Emergency Medicine, Kuopio University Hospital and University of Eastern, Finland.
  • ,
  • Robert Larsen, Division of Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University and Pain and Rehabilitation Centre, County Council of Östergötland, Linköping, Sweden
  • ,
  • Marius Rehn, Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway.
  • ,
  • Leif Rognås
  • Mårten Sandberg, University of Oslo
  • ,
  • Gunn Elisabeth Vist, Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.

Background: Pain management is one of the most important interventions in the emergency medical services. The femoral nerve block (FNB) is, among other things, indicated for pre- and post-operative pain management for patients with femoral fractures but its role in the pre-hospital setting has not been determined. The aim of this review was to assess the effect and safety of the FNB in comparison to other forms of analgesia (or no treatment) for managing acute lower extremity pain in adult patients in the pre-hospital setting. Methods: A systematic review (PROSPERO registration (CRD42018114399)) was conducted. The Cochrane and GRADE methods were used to assess outcomes. Two authors independently reviewed each study for eligibility, extracted the data and performed risk of bias assessments. Results: Four studies with a total of 252 patients were included. Two RCTs (114 patients) showed that FNB may reduce pain more effectively than metamizole (mean difference 32 mm on a 100 mm VAS (95% CI 24 to 40)). One RCT (48 patients) compared the FNB with lidocaine and magnesium sulphate to FNB with lidocaine alone and was only included here for information regarding adverse effects. One case series included 90 patients. Few adverse events were reported in the included studies. The certainty of evidence was very low. We found no studies comparing FNB to inhaled analgesics, opioids or ketamine. Conclusions: Evidence regarding the effectiveness and adverse effects of pre-hospital FNB is limited. Studies comparing pre-hospital FNB to inhaled analgesics, opioids or ketamine are lacking.

Original languageEnglish
JournalActa Anaesthesiologica Scandinavica
Volume64
Issue8
Pages (from-to)1038-1047
Number of pages10
ISSN0001-5172
DOIs
Publication statusPublished - Sep 2020

    Research areas

  • ANALGESIA, EMERGENCY-DEPARTMENT, FRACTURES, RELIEF, TRAUMA

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