Evaluation of Efficacy of Femoral Nerve Block on Pain and Anxiety in Acute Fractures of the Femur in the Emergency Department

Abstract

Introduction: Fractures around the hip and fractures of the femur are commonly encountered in the Emergency Department (ED). Effective control of pain in these fractures is of critical importance for proper radiography, reduction and splintage. Traditionally, systemic analgesics have been used for pain relief which had its own limitations both in terms of pain relief and relaxation. Use of Femoral Nerve Block (FNB) in acute fractures around the hip and femur has been a challenge and, evaluation of this procedure has been the subject of research recently in ED. Aim: To evaluate the efficacy of FNB in decreasing pain and anxiety in acute fractures of the femur. Materials and Methods: Prospective interventional study was conducted at a tertiary care centre with well-defined inclusion and exclusion criteria. Eighty four patients with fractures around the hip, fractures of the shaft and distal femur underwent ultrasound guided FNB for performance of retrieval procedures. Visual analog scale (VAS) score for pain and Hamilton Anxiety Score (HAM-A) score for anxiety were used as parameter both for pre and postblock to assess the effectiveness. Subjective assessment of the patients comfort level was also done. Statistical analysis of all data obtained was done using SPSS 21.0. Results: Study group (n=84) included in the evaluation were homogenous in terms of age and sex distribution. The mean±SD VAS score preoperatively was 72.93±10.91. At 30 minutes and 4 hours postblock,the mean±SD VAS scores were 18.65±5.25 and 13.88±6.05, respectively. There was statistically significant difference in VAS score at 30 minutes (p=0.004) and 4 hours (p=0.015). The mean Hamilton Anxiety score at preblock and 4 hour postblock was 27.05±5.94 and 8.07±3.7, respectively. The overall HAM-A score comparison showed that there was statistically significant change after 4 hours postblock (p=0.013) showing significant decrease in anxiety levels. All patients were satisfied by the comfort and ease of shifting after block. Intergroup analysis of fractures around the hip (Neck femur, Trochanter) and fractures of the shaft (Shaft femur and distal femur) revealed equal efficacy of the femoral block. Conclusion: Ultrasound guided FNB is an easy and safe means of providing pain and anxiety relief to patients with the fracture of the femur (neck femur, per-trochanteric femur, shaft femur or distal femur) in the ED. At the same time, it decreases the need of systemic analgesia.