Immediate ultrasound-guided femoral nerve block in proximal femur fractures in the emergency department

Background Sufficient pain management in proximal femoral fractures in the emergency room (ER) is important. Inadequately treated pain as well as opioids may cause delirium in these often elderly patients and is responsible for longer hospitalizations and increased mortality. Systemic opioids are often inadequate. For this reason femoral nerve block (FNB) in the ER has been discussed for some time. Objectives The aim of the study was to evaluate whether patients with these fractures benefit from ultrasound-guided FNB (UG-FNB) to reduce opioid use within the first 24x202f;h. In addition, an investigation of whether UG-FNB should be performed before or after X-ray was planned. Material and methods Patients with proximal femoral fractures were divided into three groups: conservative pain therapy (CPT), X-ray before UG-FNB (XbFB), and UG-FNB before X-ray (FBbX). FBbX was examined sonographically for femoral fractures prior to UG-FNB. Opioid use (morphine equivalent) within 24x202f;h as well as the time from admission to X-ray and to UG-FNB were determined and compared. Results From 01/19 to 12/19 95 patients (66 females, 29 males) were recorded (CPT 47, XbFB 17, FBbX 31). All UG-FNB (XbFBx202f;+ FBbX) required less morphine equivalent within 24x202f;h after admission than the CPT group (median 0x202f;+/- 3x202f;mg vs. 6x202f;+/- 13,px202f;< 0.001). The median time to X-ray without prior UG-FNB was 58x202f;min; with previous UG-FNB, 70x202f;min (px202f;= 0.007). To perform X-ray and UG-FNB, group XbFB required in median 66x202f;min more than FBbX (px202f;< 0.001). No local or systemic complications related to the UG-FNB was encountered. Conclusion UG-FNB is a rational alternative to systemic opioid therapy in pain management of proximal femur fractures in the ER. UG-FNB should be performed before X-ray.