Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Am J Emerg Med. 2010 Jan;28(1):76-81. doi: 10.1016/j.ajem.2008.09.015.
The primary objective of this study was to determine the feasibility of ultrasound-guided femoral nerve blocks in elderly patients with hip fractures in the emergency department (ED). The secondary objective was to examine the effectiveness of this technique as an adjunct for pain control in the ED.
This prospective observational study enrolled a convenience sample of 13 patients with hip fractures. Ultrasound-guided femoral nerve block was performed on all participants. To determine feasibility, time to perform the procedure, number of attempts, and complications were measured. To determine effectiveness of pain control, numerical rating scores were assessed at baseline and at 15 minutes, 30 minutes, and hourly after the procedure for 4 hours. Summary statistics were calculated for feasibility measures. Wilcoxon matched-pairs signed-rank tests and Friedman analysis of variance test were used to compare differences in pain scores.
The median age of the participants was 82 years (range, 67-94 years); 9 were female. The median time to perform the procedure was 8 minutes (range, 7-11 minutes). All procedures required only one attempt; there were no complications. After the procedure, there were 44% and 67% relative decreases in pain scores at 15 minutes (P < or = .002) and at 30 minutes (P < or = .001), respectively. Pain scores were unchanged from 30 minutes to 4 hours after the procedure (P < or = .77).
Ultrasound-guided femoral nerve blocks are feasible to perform in the ED. Significant and sustained decreases in pain scores were achieved with this technique.
本研究的主要目的是确定在急诊科（ED）中对髋部骨折的老年患者进行超声引导股神经阻滞的可行性。次要目的是检验该技术作为 ED 中疼痛控制辅助手段的有效性。
这项前瞻性观察性研究纳入了 13 例髋部骨折的便利样本患者。所有参与者均接受超声引导股神经阻滞。为了确定可行性，测量了操作的时间、尝试次数和并发症。为了确定疼痛控制的效果，在基线和操作后 15 分钟、30 分钟和 1 小时以及 4 小时评估数字评分。对可行性测量值计算了汇总统计量。采用 Wilcoxon 配对符号秩检验和 Friedman 方差分析检验比较疼痛评分的差异。
参与者的中位年龄为 82 岁（范围，67-94 岁）；9 名为女性。操作的中位时间为 8 分钟（范围，7-11 分钟）。所有操作仅需一次尝试；无并发症。操作后 15 分钟（P≤.002）和 30 分钟（P≤.001）时疼痛评分分别降低了 44%和 67%，相对降低。从 30 分钟到 4 小时后，疼痛评分没有变化（P≤.77）。
超声引导股神经阻滞在 ED 中易于实施。该技术可显著且持续降低疼痛评分。
