Centre for Prehospital Emergency Care, Oulu University Hospital, Oulu, Finland.
Anaesthesia Research group, MRC, Oulu University Hospital and University of Oulu, Oulu, Finland.
Acta Anaesthesiol Scand. 2020 Sep;64(8):1038-1047. doi: 10.1111/aas.13600. Epub 2020 Apr 24.
Pain management is one of the most important interventions in the emergency medical services. The femoral nerve block (FNB) is, among other things, indicated for pre- and post-operative pain management for patients with femoral fractures but its role in the pre-hospital setting has not been determined. The aim of this review was to assess the effect and safety of the FNB in comparison to other forms of analgesia (or no treatment) for managing acute lower extremity pain in adult patients in the pre-hospital setting.
A systematic review (PROSPERO registration (CRD42018114399)) was conducted. The Cochrane and GRADE methods were used to assess outcomes. Two authors independently reviewed each study for eligibility, extracted the data and performed risk of bias assessments.
Four studies with a total of 252 patients were included. Two RCTs (114 patients) showed that FNB may reduce pain more effectively than metamizole (mean difference 32 mm on a 100 mm VAS (95% CI 24 to 40)). One RCT (48 patients) compared the FNB with lidocaine and magnesium sulphate to FNB with lidocaine alone and was only included here for information regarding adverse effects. One case series included 90 patients. Few adverse events were reported in the included studies. The certainty of evidence was very low. We found no studies comparing FNB to inhaled analgesics, opioids or ketamine.
Evidence regarding the effectiveness and adverse effects of pre-hospital FNB is limited. Studies comparing pre-hospital FNB to inhaled analgesics, opioids or ketamine are lacking.
疼痛管理是急救医疗服务中最重要的干预措施之一。股神经阻滞（FNB）除其他外，还用于股骨骨折患者的围手术期疼痛管理，但在院前环境中的作用尚未确定。本综述的目的是评估 FNB 与其他形式的镇痛（或无治疗）相比，在院前环境中用于管理成人急性下肢疼痛的效果和安全性。
进行了系统评价（PROSPERO 注册（CRD42018114399））。使用 Cochrane 和 GRADE 方法评估结果。两名作者独立审查了每项研究的资格，提取数据并进行了偏倚风险评估。
纳入了四项研究，共 252 名患者。两项 RCT（114 名患者）表明，FNB 可能比美洛昔康更有效地减轻疼痛（100mm VAS 上的平均差异为 32mm（95%CI 24 至 40））。一项 RCT（48 名患者）比较了 FNB 与利多卡因和硫酸镁与单独使用利多卡因的 FNB，仅在此处包含该研究是为了了解不良反应信息。一项病例系列纳入了 90 名患者。纳入的研究报告了很少的不良事件。证据的确定性非常低。我们没有发现将 FNB 与吸入性镇痛药、阿片类药物或氯胺酮进行比较的研究。
关于院前 FNB 的有效性和不良反应的证据有限。缺乏将院前 FNB 与吸入性镇痛药、阿片类药物或氯胺酮进行比较的研究。
