Hartmann Flávia Vieira Guimarães, Novaes Maria Rita Carvalho Garbi, de Carvalho Marta Rodrigues
Hospital de Base do Distrito Federal, Brasília, DF, Brazil; Hospital Militar de Área de Brasília, Brasília, DF, Brazil; Fundacão de Ensino e Pesquisa em Ciências da Saúde, Brasília, DF, Brazil; Escola Superior de Ciências da Saúde, Brasília, DF, Brazil.
Farmácia Hospitalar, Departamento de Saúde, Brasília, DF, Brazil; Universidad del Chile, Santiago, Chile; Fundação de Ensino e Pesquisa em Ciências da Saúde, Escola Superior de Ciências da Saúde, Brasília, DF, Brazil.
Braz J Anesthesiol. 2017 Jan-Feb;67(1):67-71. doi: 10.1016/j.bjane.2015.08.017. Epub 2016 Apr 19.
Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg.
To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales.
A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time.
Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this.
The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.
髋部骨折是一个重要的公共卫生问题，与高死亡率和功能丧失相关。髋部骨折是指发生在股骨头边缘至小转子下方5厘米之间的骨折。它们在骨科急诊中很常见。随着人口老龄化，股骨近端骨折的数量可能会增加。髋部骨折初次住院期间的平均护理费用估计约为每位患者7000美元。股骨骨折疼痛剧烈，需要立即进行充分的镇痛。治疗股骨骨折的疼痛很困难，因为可用的镇痛药数量有限，其中许多都有副作用，可能会限制其使用。阿片类药物是最常用的药物，但它们会带来一些并发症。在这种情况下，股神经阻滞可能是一种安全的替代方法。它是急诊医学医生使用的一种特定区域麻醉技术，用于为患侧腿部提供麻醉和镇痛。
通过疼痛量表评估，比较股骨骨折患者在进行脊髓麻醉定位前静脉注射芬太尼与股神经阻滞的镇痛效果。
对科学文献进行系统综述。纳入描述为比较股神经阻滞和传统芬太尼的随机对照试验的研究。两名评审员（MR和FH）独立评估可能符合纳入标准的试验。方法学评估基于Cochrane协作网开发的用于评估随机对照试验偏倚的工具。检索Cochrane图书馆、Pubmed、Medline和Lilacs中所有发表的文章，不受语言或时间限制。
本综述纳入两项研究。神经阻滞在预防股骨骨折患者疼痛方面似乎比静脉注射芬太尼更有效。它还减少了额外镇痛药的使用，并降低了全身并发症的风险。股神经阻滞缩短了接受手术患者进行脊髓麻醉的时间，并便于患者采取坐位。
使用股神经阻滞可以降低疼痛程度和对额外镇痛的需求。与此相关的全身不良事件较少，且该操作本身风险不大。需要更多研究以得出进一步结论。
