Mutty Christopher E, Jensen Erik J, Manka Michael A, Anders Mark J, Bone Lawrence B
Erie County Medical Center, State University of New York at Buffalo, Buffalo, New York, USA.
J Bone Joint Surg Am. 2008 Oct;90 Suppl 2 Pt 2:218-26. doi: 10.2106/JBJS.H.00314.
Diaphyseal and distal femoral fractures are painful injuries that are frequently seen in patients requiring a trauma work-up in the hospital emergency department prior to definitive management. The purpose of this study was to determine whether a femoral nerve block administered in the emergency department could provide better pain relief for patients with femoral fractures than currently used pain management practices.
Patients who presented with an acute diaphyseal or distal femoral fracture were identified as potential candidates for this study. Eligible patients were randomized by medical record number to receive either (a) the femoral nerve block (20 mL of 0.5% bupivacaine) along with standard pain management or (b) standard pain management alone (typically intravenous narcotics). The pain was assessed with use of a visual analog scale at the initial evaluation and at five, fifteen, thirty, sixty, and ninety minutes following the initial evaluation. Fifty-four patients were enrolled in the study from April 2005 to May 2006. Thirty-one patients received a femoral nerve block, and twenty-three patients received standard pain management alone.
Baseline scores on the visual analog pain scale did not differ between the groups at the initial evaluation. The patients who received a femoral nerve block (along with standard pain management) had significantly lower pain scores at five, fifteen, thirty, sixty, and ninety minutes following the block than did the patients who received standard pain management alone (p < 0.001). The score on the visual analog pain scale across these time points was an average of 3.6 points less (on a 10-point scale) for those who received the block. There were no infections, paresthesias, or other complications related to the femoral nerve block.
The acute pain of a diaphyseal or distal femoral fracture can be significantly decreased through the use of a femoral nerve block, which can be administered safely in the hospital emergency department.
股骨干和股骨远端骨折是疼痛性损伤，在医院急诊科需要进行创伤检查以便最终治疗的患者中很常见。本研究的目的是确定在急诊科实施股神经阻滞是否比目前使用的疼痛管理方法能为股骨骨折患者提供更好的疼痛缓解。
确定出现急性股骨干或股骨远端骨折的患者为本研究的潜在候选人。符合条件的患者通过病历号随机分组，接受以下两种治疗之一：(a)股神经阻滞（20毫升0.5%布比卡因）加标准疼痛管理，或(b)仅标准疼痛管理（通常为静脉注射麻醉剂）。在初始评估时以及初始评估后的5、15、30、60和90分钟使用视觉模拟量表评估疼痛程度。2005年4月至2006年5月，54名患者纳入本研究。31名患者接受股神经阻滞，23名患者仅接受标准疼痛管理。
初始评估时，两组的视觉模拟疼痛量表基线评分无差异。接受股神经阻滞（加标准疼痛管理）的患者在阻滞后5、15、30、60和90分钟的疼痛评分显著低于仅接受标准疼痛管理的患者（p<0.001）。在这些时间点，接受阻滞的患者视觉模拟疼痛量表评分平均低3.6分（满分10分）。未出现与股神经阻滞相关的感染、感觉异常或其他并发症。
通过使用股神经阻滞可显著减轻股骨干或股骨远端骨折的急性疼痛，且可在医院急诊科安全实施。
