Changes in the tumor necrosis factor-α level after an ultrasound-guided femoral nerve block in elderly patients with a hip fracture

Abstract

Background and objectivesAn ultrasound guided femoral nerve block is an established analgesic method in patients with a hip fracture. Elevated cytokine levels correlate with poor patient outcomes after surgery. Hence, the aim of the study was to describe the levels of tumor necrosis factor-α after an ultrasound-guided femoral nerve block in elderly patients having a femoral neck fracture. MethodsA total of 32 patients were allocated into two treatment groups: 16 patients (femoral nerve block group; ultrasound-guided femoral nerve block with up to 20mL of 0.3mL.kg−1 of 0.5% bupivacaine and intravenous tramadol) and 16 patients (standard management group; up to 3mL of 0.9% saline in the femoral sheath and intravenous tramadol). Tumor necrosis factor-α and visual analogue scale scores were evaluated immediately before the femoral nerve block and again at 4, 24, and 48h after the femoral nerve block. All surgery was performed electively after 48h of femoral nerve block. ResultsThe femoral nerve block group had a significantly lower mean tumor necrosis factor-α level at 24 (4.60 vs. 8.14, p<0.001) and 48h (5.05 vs. 8.56, p<0.001) after the femoral nerve block, compared to the standard management group. The femoral nerve block group showed a significantly lower mean visual analogue scale score at 4 (3.63 vs. 7.06, p<0.001) and 24h (4.50 vs. 5.75, p<0.001) after the femoral nerve block, compared to the standard management group. ConclusionsUltrasound-guided femoral nerve block using 0.3mL.kg−1 of 0.5% bupivacaine up to a maximum of 20mL resulted in a significant lower tumor necrosis factor-α level.