Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
Department of Orthopaedics and Traumatology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
J Emerg Med. 2020 Apr;58(4):553-561. doi: 10.1016/j.jemermed.2019.12.033. Epub 2020 Feb 16.
The local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management.
The aim of this study was to determine the success of lower local anesthetic dosages capable of reducing costs and excessive exposure to drugs in pain control in patients with femoral neck fractures (FNFs) in the ED.
Patients ≥65 years of age with FNFs and reporting Wong-Baker Pain Rating Scales scores ≥8 were included in this prospective, interventional study. Patients underwent ultrasound-guided regional femoral block with 5 mL 2% prilocaine. Pain scores before the procedure and at 30 min and 2 h postprocedure were compared with the Friedman test and Wilcoxon test with Bonferroni correction.
Forty patients, 20 with intracapsular and 20 with extracapsular FNFs, were enrolled. The initial pain scores of patients with both intra- and extracapsular fractures were 8 (range 8-10). A statistically significant 50% decrease in pain scores was observed in both groups 30 min after the regional block procedure (p < 0.001). A statistically significant 75% decrease in pain scores was observed in both groups 2 h after the regional block procedure (p < 0.001). No statistically significant difference was determined in the change in 30-min and 2-h pain scores between the groups.
The administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures.
当前局部麻醉剂在区域应用中的局部麻醉剂量常因手术目的而较高，且在急诊科（ED）管理中缺乏充分的剂量研究。
本研究旨在确定较低局部麻醉剂量在 ED 中治疗股骨颈骨折（FNF）患者疼痛控制中的效果，以降低成本和减少药物暴露。
本前瞻性干预研究纳入了年龄≥65 岁、Wong-Baker 疼痛评分量表（FPS）≥8 分且有 FNF 的患者。所有患者均接受超声引导下的股神经阻滞，使用 2%普鲁卡因 5 mL。比较患者术前、术后 30 分钟和 2 小时的疼痛评分，采用 Friedman 检验和 Wilcoxon 检验，并用 Bonferroni 校正。
共纳入 40 例患者，其中 20 例为囊内骨折，20 例为囊外骨折。两组患者的初始 FPS 评分均为 8 分（8-10 分）。在区域阻滞后 30 分钟，两组患者的疼痛评分均显著下降 50%（p < 0.001）。在区域阻滞后 2 小时，两组患者的疼痛评分均显著下降 75%（p < 0.001）。两组患者的 30 分钟和 2 小时疼痛评分变化无统计学差异。
在 ED 中为老年 FNF 患者使用 5 mL 2%普鲁卡因可在囊内和囊外骨折中建立有效镇痛，从而减少全身镇痛需求。
