Femoral Nerve Block Research Articles

A rare bifurcation of the external iliac artery into femoral and deep femoral arteries

The current cadaveric report describes a quite rare unilateral bifurcation of the external iliac artery (EIA) into two femoral arteries (FAs) of almost equal diameter and parallel course, at the level of the inguinal ligament (IL). The variant FAs were identified on a 75-year-old formalin-embalmed female cadaver, derived from a body donation program after a signed informed consent. The EIA bifurcated into a FA and a deep femoral artery (DFA). The DFA extremely high origin was identified at the IL level. Both lateral and medial circumflex femoral arteries originated from the DFA. The in-depth knowledge of the FA variant origin is of paramount importance to vascular surgeons and interventional radiologists during vessel catheterization and attempts to interpret the angiographic findings. In particular, the DFA's high origin from the EIA and the coexistence of two FAs in a parallel course may pose problems to clinicians during angiographic procedures leading to diagnostic errors. The DFA high origin may also complicate femoral arterial and venous puncture and femoral nerve blocks, due to the close neurovascular relationship. There is a possibility for the FA to be mistaken for a vein leading to accidental intra-arterial injection and consequently thrombosis. Thus, variable arterial pattern is important to be identified preoperatively using Doppler ultrasound imaging.

Pericapsular nerve group (PENG) block for hip arthroscopy: a randomized, double-blinded, placebo-controlled trial

IntroductionArthroscopic hip surgery is associated with significant postoperative pain. Femoral nerve blocks have been shown to improve postoperative analgesia at the expense of quadriceps weakness. The pericapsular nerve group (PENG)...

Ultrasound Guided Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve Block for Perioperative Analgesia in a Patient with Ischemic Heart Disease on Anticoagulants Posted for Corrective Hip Surgery

Introduction : Ultrasound guided pericapsular nerve group block is an approach to block the articular branches of femoral, obturator and accessory obturator nerves that supply the anterior hip capsule and has been found to provide good perioperative analgesia. Case Report: An 86 year old male, who suffered fracture neck of femur after an alleged slip and fall, was posted for emergency corrective surgery. Perioperative evaluation revealed ischemic heart disease, status post PTCA with preserved LV systolic function and on oral anticoagulant rivaroxaban and antiplatelet medication clopidogrel. Coagulation profile was within acceptable range. Cardiac Troponins and Brain Natriuretic peptide (BNP) were measured. General anesthesia was planned to this patient in view of relative contraindication to central neuraxial block i.e. patient being on anticoagulants. Perioperative analgesia was provided with ultrasound guided pericapsular nerve group block for fracture site pain and lateral femoral cutaneous nerve block for surgical incision pain. Patient had stable hemodynamic with improved pain score (VAS & lt; 3) in the immediate postoperative period. There was no evidence of post-operative delirium and perioperative myocardial injury. Conclusion : Ultrasound guided superficial regional nerve group block such as Pericapsular nerve group block, lateral femoral cutaneous nerve block can provide effective postoperative analgesia in patients where central neuraxial blocks are contraindicated. Keywords : Anticoagulants, Hip fracture, Regional anesthesia. Key Messages: Acute pain management in elderly patients is quite challenging to anesthesiologists due to medical comorbidities such as ischemic heart disease patients who experience greater pain are at increase risk in post operative period and patients on anticoagulants where central neuraxial blockade are contraindicated. Perioperative analgesia helps in intraoperative hemodynamic stability and post operative analgesia.

Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty

BackgroundNear-falls should be detected to prevent falls related to the earlier ambulation after Total knee arthroplasty (TKA). The quadriceps weakness with femoral nerve block (FNB) has led to a focus on adductor canal block (ACB). We purposed to examine the risk of falls and the earlier ambulation in each continuous infusion nerve block.MethodsContinuous infusion nerve block (FNB or ACB) was performed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who could ambulate on POD 1, was investigated.ResultsA total of 73 TKA cases, 36 FNB and 37 ACB, met the inclusion criteria. No falls were noted. But episodes of near-falls with knee-buckling were witnessed in 14 (39%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients could ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) and rescue analgesia through POD 3.ConclusionACB was associated with significantly less knee-buckling and earlier ambulation post-TKA, with better quadriceps strength. Our study indicated the incidence of falls and near-falls with continuous infusion nerve blocks, and support the use of ACB to reduce the risk of falls after TKA. It is suggested that a certain number of the patients even with continuous ACB infusion should be considered with the effect of motor branch to prevent falls.

Pain levels and patient comfort after lower limb arthroplasty comparing i.v. patient-controlled analgesia, continuous peripheral nerve block and neuraxial analgesia: a retrospective cohort analysis of clinical routine data

BackgroundInsufficient pain control after lower limb arthroplasty results in delayed recovery and increased risk for pain chronicization. The ideal kind of analgesia is still discussed controversially. We conducted a retrospective analysis of single-center routine data from a German university hospital, including patients receiving either total hip (THA) or knee arthroplasty (TKA).MethodsAll patients received general anesthesia. Patients undergoing THA received either continuous epidural ropivacaine infusion (0.133%, Epi) or patient-controlled analgesia (PCA) with the Wurzburg Pain Drip (tramadol, metamizole and droperidol, WPD) or with piritramide (Pir). After TKA, patients received either continuous femoral nerve block (ropivacaine 0.2%, PNB) or Pir.ResultsThe analyzed cohort comprised 769 cases. Use of WPD after THA (n = 333) resulted in significantly reduced Numeric Rating Scale (NRS) values at rest, compared to Epi (n = 48) and Pir (n = 72) (.75 [IQR 1.14] vs. 1.17 [1.5], p = .02 vs. 1.47 [1.33], p < .0001) as well as maximum NRS scores (2.4 [1.7] vs. 3.29 [1.94], p < .001 vs. 3.32 [1.76], p < .0001). Positive feedback during follow-up visits was significantly increased in patients with a WPD PCA (p < .0001), while negative feedback (senso-motoric weakness/technical problems/nausea/dizziness/constipation) was particularly increased in Epi patients and lowest in those with WPD (p < .0001). After TKA, Pir (n = 131) resulted in significantly reduced NRS values at rest, compared to PNB (n = 185) (1.4 [1.4] vs. 1.6 [1.68], p = .02). Positive feedback was increased in patients with a Pir PCA in comparison with PNB (p = .04), while negative feedback was increased in PNB patients (p = .04). Overall, WPD presented with the lowest rate of any complications (8.7%), followed by Pir (20.2%), PNB (27.6%) and Epi (31.3%) (p < .001).ConclusionsIn the assessed population, the use of a WPD PCA after THA offered better pain control and patient comfort in comparison with continuous epidural or piritramide-based analgesia. After TKA, the use of a Pir PCA provided superior analgesia and a lower complication rate compared to continuous PNB.

Treatment of pain syndrome after total hip arthroplasty associated with femora nerve entrapment

BACKGROUND: The problem of pain syndrome after total hip replacement remains unresolved, including 3.5% of all revision interventions performed for pain of unclear etiology.&#x0D; AIMS: to study the clinical picture of the pain syndrome that occurs after total hip replacement that is not associated with mechanical and septic instability of the components of the endoprosthesis; to develop methods for correcting the pain syndrome.&#x0D; MATERIALS AND METHODS: The examination was carried out by patients (n=23) with complaints of pain in the groin and on the anterior surface of the thigh, who had a history of primary total hip replacement performed 3 months ago. The circumference of the hip was measured for the patients, and a visual assessment of the pose in an upright position was carried out. Stimulation electroneuromyography of the conductive function of the motor fibers of the femoral nerve was performed on both sides at the level of the inguinal ligament, the parameters of terminal latency (L, ms) and the amplitude of the M-response (A, mV) were evaluated. Needle electroneuromyography of the iliac muscle was performed in order to diagnose its pathological shortening before the start of treatment and 6 months after its completion. A complex of rehabilitation measures has been developed, including therapeutic blockade of the femoral nerve, physiotherapy treatment and individual physical therapy classes. Treatment results were evaluated using a visual analog scale (VAS), Oswestry and DN4 questionnaires before and after therapy.&#x0D; RESULTS: Pathological changes of the femoral nerve from the operated joint were revealed in 23 (100%) patients. Needle electroneuromyography data indicated pathological shortening of the ilio-lumbar muscle in 19 (82%) of them. The quality of life according to Oswestry is 49.3415.63%, the level of pain syndrome according to VAS is on average 8.001.50 points, the average DN4 score is 4.351.58. The length of the hip circumference was 2.200.65 cm in favor of a healthy lower limb. When performing a femoral nerve blockade at the level of the inguinal ligament, the level of pain syndrome 510 minutes after administration of the drug was, according to VAS, 1.421.01 points. After 1 month from the start of rehabilitation treatment , the results of the survey are as follows: VAS 0.911.12 points, DN4 1.01.50 points, Oswestry 16.785.79%. The difference in the length of the hip circumference averaged 1.560.55 cm in favor of a healthy limb. The results of stimulation electroneuromyography after 6 months against the background of ongoing rehabilitation treatment showed an increase in the amplitude of the muscle response from total hip replacement by an average of 0.76 mV; according to needle electroneuromyography, normalization of the tone of the ilio-lumbar muscle on both sides was demonstrated.&#x0D; CONCLUSIONS: In patients in the postoperative period of total hip replacement, pain syndrome is associated with the formation of compression-ischemic neuropathy of the femoral nerve from the side of the operated joint, which is due to a decrease in the tone of the rectus femoris muscle and a stable pathological tone of the ilio-lumbar muscle on the operated side. Comprehensive restorative treatment aimed at eliminating perineural inflammation, the release of pathologically shortened muscles, as well as muscle retraining, give a positive result in the rehabilitation of patients with pain syndrome in the late postoperative period of total hip replacement.

Multimodal analgesic technique in a peacock (Pavo cristatus) anaesthetised for orthopaedic surgery

AbstractA 6‐month‐old, male peacock (Pavo cristatus) underwent right‐sided corrective tibiotarsal osteotomy under general anaesthesia. Butorphanol (1 mg/kg) and midazolam (1 mg/kg) were administered in the pectoral muscle as pre‐anaesthetic medications. Anaesthesia was induced with intravenous alfaxalone (2.5 mg/kg) and maintained with isoflurane in oxygen. Intermittent positive‐pressure ventilation was applied. A nerve stimulator‐guided femoral nerve block and a nerve stimulator‐ and ultrasound‐guided sciatic nerve block were performed before surgery with lidocaine. An intravenous bolus of ketamine (1 mg/kg), followed by infusion (20 µg/kg/min) was administered intraoperatively. No nociception was recorded during surgery. This case report describes a successful multimodal analgesic technique in a peacock anaesthetised for orthopaedic surgery.

Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia.

Total Knee Arthroplasty (TKA) is an increasingly common procedure performed for advanced osteoarthritis. Optimal perioperative pain management strategies are critical for early mobilization and shorter hospital stays in TKA. Peripheral nerve blocks commonly used in TKA perioperative analgesia including individual and combined femoral, obturator, sciatic, lumbar plexus, and adductor canal nerve blocks. Overall, the safety profile varies depending on which block is utilized, but the current evidence suggests when optimally chosen and delivered, peripheral nerve blocks may provide a safe, effective option for perioperative analgesia. Determining optimal analgesic regimens for total knee arthroplasty is critical to improve postoperative pain, patient satisfaction, decreasing opioid usage, recovery times and functional outcomes, and as such, peripheral nerve blocks may represent a viable option to supplement analgesic requirements in the perioperative period.

Postoperative Pain Control by Local Infiltration Analgesia and Peripheral Nerve Block in Primary Prosthetic Total Knee Arthroplasty.

Background and ObjectivePostoperative (post-op) pain control has an important impact on post-op rehabilitation. The logistics of its maintenance challenge the effect of peripheral nerve block on post-op pain control, with the risk for post-op complications. We hypothesized that perioperative use of local infiltration analgesia (LIA) is comparable to post-op pain control by peripheral nerve block.Materials and MethodsWe evaluated three groups of patients treated with primary total knee arthroplasty (TKA) due to symptomatic end-stage osteoarthritis with post-op pain control by LIA (LIA group, n=52), femoral plus sciatic nerve block (FSNB) (FSNB group, n=54), and without local or regional analgesia as controls (Control group, n=53). The primary outcome variable was the post-op pain level intensity as measured by the visual analog scale (VAS). Secondary outcome variables were knee function measured by the Knee Society Score (KSS) and the quadriceps muscle strength recovery profile.ResultsUp to 4 hours post-op, pain intensity was significantly lower in FSNB patients (P<0.05). This effect of the peripheral nerve block on the pain level disappeared 6 hours post-op. The LIA and FSNB patients showed a significant decrease in pain intensity on days 2 and 3 post-op (P<0.05) with no mutual differences (P>0.05). This effect disappeared on day 4 post-op (P>0.05). The KSS score showed similar significant improvement of functional abilities (P<0.001) in all three groups. There was no difference in KSS scores among the groups 6 months after surgery (P>0.05). Quadriceps muscle recovery profile was similar in the LIA and Control groups, but significantly poorer in the FSNB group (P<0.001).ConclusionThe value of very short-term and improved pain relief of post-op FSNB over LIA of the surgical wound should be carefully weighed against its cost, logistics, and potential complication threat.

General, spinal or regional anaesthesia does not affect strength performance 6 months after ACL reconstruction

PurposeThe recovery of strength is a key element in successfully returning to sports after ACL reconstruction. The type of anaesthesia has been suspected an influential factor in the post-operative recovery of muscle function.MethodsIn this retrospective analysis, n = 442 consecutive patients undergoing primary isolated ACL reconstruction using a hamstring autograft were analysed by pre- and post-operative isokinetic tests in a single orthopaedic centre. These were subdivided into four cohorts: (1) general anaesthesia (n = 47), (2) general anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 37), (3) spinal anaesthesia (n = 169) and (4) spinal anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 185). Primary outcome was the change from pre- to post-operative isokinetic strength during knee extension and flexion.ResultsUsing one-way ANOVA, there was no significant influence of the type of anaesthesia. The main effect of anaesthesia on change in extension forces was not significant, and effect sizes were very small (n.s.). Similarly, the main effect of anaesthesia on change in flexion forces was statistically not significant (n.s.).ConclusionsThe findings of this study support the interpretation that the type of anaesthesia has no significant effect on the ability to recover thigh muscle strength 6 months after isolated hamstring ACL reconstruction. With regard to the recovery of athletic performance and return-to-sports testing criteria, there is no reason to avoid regional anaesthesia.Level of evidenceIII.

Saphenous nerve block versus femoral nerve block in enhanced recovery after knee replacement surgery under spinal anaesthesia

BackgroundInadequate pain management after total knee replacement (TKR) prolongs recovery time and increases the risk of postoperative complications. Peripheral nerve fibres blockade has been used as a mode of analgesia after TKR. Femoral nerve block (FNB) is often used to provide postoperative analgesia after TKR. However, FNB causes quadriceps muscle weakness leading to delayed ambulation, patient discomfort and prolonged hospital stay. Nowadays, saphenous nerve block is a relatively new alternative being superior to FNB for providing pure blockage of sensory nerve fibres with preserving quadriceps muscle strength.ResultsResults of this study showed that leg raising test percentages were significantly higher in group S compared to group F (86.7% versus 43.3% respectively), whereas, time up and go (TUG) test values were significantly lower in group S compared to group F (Mean ±SD values were 22.47 ± 4.93 versus 44.6 ± 4.18 respectively with a p-value < 0.0001). Numerical rating score (NRS) for pain scoring was measured at 30 min after admission to PACU, 3, 6, 12 and 24hrs postoperatively showed no significant differences in both groups F & S (1;(0-2), 1;(1-2), 2;(1-2), 2;(1-2), 2;(2-2) versus 1;(0-2), 1;(1-2), 2;(1-3), 2;(1-2), 2;(2-3) respectively with a p-value 0.42, 0.1, 0.1, 0.49, 0.67). Also, both groups showed no significant difference in cumulative 1st 24hrs Nalbuphine consumption (Mean ±SD were 15.33 ± 7.3 for F group versus 14.33 ± 6.26 for S group with a p-value 0.57).ConclusionsDespite the excellent analgesic effect of FNB, saphenous nerve block could be a favorable choice as a mode of analgesia after TKR, as it preserves quadriceps motor strength and promotes early mobilization compared to FNB.

Translated article] Implementation of a rapid recovery protocol in total knee arthroplasty. A randomised controlled trial

BackgroundRapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery programme compared to our classic protocol. Patients and methodsWe performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4–6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal.All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made 1 month after discharge. Minimum follow-up was of 6 months. ResultsA total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, haemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford knee score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%).Significancy was found on time of ischaemia (C: 81.29min; RP: 85.35min; p=.03), need for morphine shots (C: 19.7%; RP: 38.6%; p=.007), hospital stay (C: 3.84 days; RP: 2.54 days, p<.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; p<.0001). ConclusionRapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.

Peripheral nerve block compared to peri-articular injection for postoperative pain control in total ankle arthroplasty: A randomized, controlled, non-inferiority trial

Background Peripheral nerve blocks (PNB) are widely used for postoperative pain management, including total ankle arthroplasty (TAA), but introduce potential neuropathic complications. This study evaluates the effectiveness and tolerability of peri-articular injections (PAI) compared to PNB in TAA, measured by narcotic consumption and pain scores. Methods A prospective, non-inferiority trial randomized 51 adults undergoing primary, unilateral TAA, to either PAI (n=26) or a popliteal fossa with distal femoral nerve block (n=25). Outcomes included mean difference (MD) in postoperative morphine milligram equivalents (MME) consumption and Visual Analogue Pain Scale (VAS, 0-100mm) at 24 hours and two weeks, and complications through three months. Non-inferiority margins were MD in narcotic consumption less than 30 MME (24 hour) and 75 MME (two weeks), and MD less than 15mm on VAS using the upper limit of one-sided 95% confidence intervals (UCI). Results Complete data were available for 23 participants with PAI and 18 with PNB. Mean 24 hour MME was 53.6 (sd = 47.5) in PAI versus 57.2 (sd = 44.0) in PNB (p=.711) with 3.6 MME MD (UCI 32.6). Mean VAS at 24 hours was 25.1 (sd = 24.7) in PAI compared to 25.2 (sd = 29.4) in PNB (p=.991) with MD -0.09 (UCI 17.0). At two-weeks, MD in MME was 80.8 (UCI 363.3). Non-inferiority was not supported for these outcomes. Mean two week VAS was 14.6 (sd = 24.7) in PAI versus 16.4 (sd = 21.0) for PNB (p=.828) with MD of -1.9 (UCI 10.4), supporting non-inferiority. Conclusion PAI offers a simple approach to pain control in TAA that should be considered. There were no significant differences in 24 hour or two week postoperative pain, or complications for patients randomized to PAI compared to PNB. Further research will likely demonstrate PAI is no worse than PNB for postoperative pain control and avoids potential neuropathic complications.

“COMPARISON OF ANALGESIC EFFECT OF INTRAVENOUS FENTANYL VS FEMORAL NERVE BLOCK DURING SPINAL ANESTHESIA POSITIONING IN PATIENTS UNDERGOING FEMUR FRACTURE SURGERY.”

Introduction: For operative procedures of femur fracture, spinal anaesthesia is widely used over general anaesthesia with advantages of better post-operative pain relief, early mobilization, less respiratory complications and avoiding multiple drugs usage. For effectively giving spinal anaesthesia, pain free positioning is must. While giving spinal anesthesia in femur fracture procedures, proper positioning of patient is very difcult because of pain, more so when fracture is displaced. Thus pre operatively intravenous fentanyl, femoral nerve block or fascia iliaca block are some of the procedures which can be used to decrease pain and to provide correct positioning during spinal anaesthesia. To compare theObjectives: analgesic effect and hemodynamic stability of femoral nerve block and intravenous fentanyl. Study was carry out on 70 patients dividedMethods: randomly into two groups of 35 patients each. Group A patients received Femoral nerve block and Group B patients received intravenous fentanyl. Result: VAS score at rest and at movement at 15 minutes in femoral nerve block group was 2.37 +/- 1.45 and 3.37+/- 1.55 in intravenous fentanyl group was 4.94+/- 0.98 and 5.55+/- 0.88.Patient satisfaction score was higher in femoral nerve block group. Analgesic effect ofConclusion: femoral nerve block was better compare to intravenous fentanyl.

Combined proximal or distal nerve blocks for postoperative analgesia after total knee arthroplasty: a randomised controlled trial

BackgroundMany regional anaesthetic techniques have been proposed to manage pain after total knee arthroplasty, but the best approach is unclear. We compared opioid consumption in the first 48 h between two different regional anaesthesia strategies in patients undergoing total knee arthroplasty. MethodsIn this single-centre, prospective study, we randomly allocated 90 patients to a combination of IPACK (interspace between popliteal artery and capsule of the posterior knee), triangle femoral and obturator nerve blocks (distal group), or a combination of sciatic, femoral, obturator, and lateral femoral cutaneous nerve blocks (proximal group). All patients received an opioid-sparing general anaesthesia regimen. The primary outcome was opioid consumption in the first 48 h. Secondary outcomes included opioid consumption in the first 24 h and verbal rating pain scores in the first 48 h. ResultsThere was no difference in median cumulative oral morphine equivalent consumption at 48 h between the distal and the proximal block groups (33 [18–78] mg vs 30 [22–51] mg, respectively; P=0.29). Median oral morphine equivalent consumption at 24 h was higher in the distal group compared with the proximal group (30 [13–59] vs 15 [0–18], respectively; P<0.001). Verbal rating pain scores were lower in the proximal group compared with the distal group on arrival to the postanaesthesia care unit and at 6 and 12 h. ConclusionsIn patients undergoing total knee arthroplasty under total intravenous general anaesthesia with a multimodal analgesia regimen, proximal nerve blocks resulted in improved pain scores in the first 12 h and reduced opioid consumption in the first 24 h when compared with distal nerve blocks. No difference in pain scores or opioid consumption was seen at 48 h. Clinical trial registrationNCT 04499716.

Femoral and Lateral Femoral Cutaneous Nerve Block as Anesthesia for High-Risk Intertrochanteric Fracture Repair Patients.

Introduction. Intertrochanteric fracture (IF) is a common injury among the elderly. Due to significant comorbidities, anesthesia for IF repair may be challenging. The authors propose femoral nerve block together with a lateral femoral cutaneous nerve block and sedation as an anesthetic technique for most severe cases of IF with contraindications to spinal anesthesia. Methods. In total, 61 patients were enrolled prospectively in a study, 19 received general anesthesia (GA group), 22 spinal anesthesia (SA group), and 20 nerve blocks with sedation (PNB group). Results. Groups were comparable in terms of age, gender, independence, and several comorbidities: diabetes, obesity, underweight, cardiovascular, and cerebrovascular incidents in the past, dementia, chronic obstructive pulmonary disease, and frailty. Heart failure (p = 0.033), hemoglobin < 10 g/dL (p = 0.001) and eGFR < 30 mL/min (p = 0.039) were more frequent in PNB group. PNB group had higher American Society of Anesthesiologists (ASA) (p < 0.001), Nottingham Hip Fracture Score (NHFS) (p < 0.001), and Charlson Comorbidity Index (CCI) (p = 0.002) scales scores, and lower probability of 10-year survival according to CCI (p = 0.012). GA group had more frequent active malignancy (p = 0.041). GA and PNB groups had a higher frequency of hemostasis disorder (p < 0.001). Surgery was completed under the scheduled anesthesia technique. Survival, frequency of cardio and cerebrovascular incidents after surgery, loss of independence, and postoperative delirium were comparable between groups, as well as the length of postoperative stay. Conclusions. Surgical repair of intertrochanteric fracture with intramedullary nailing system among elderly, frail, and sick patients can be conducted under peripheral nerve block. FNB and LFCNB in the combination is a viable option for IT fracture repair.

Comparison of Femoral Nerve Block and Fascia Iliaca Block for Proximal Femoral Fracture in the Elderly Patient: A Meta-analysis.

IntroductionPain management modalities after proximal femoral fracture are variable and have been studied extensively. Regional anesthesia, specifically femoral nerve (FNB) and fascia iliaca compartment blocks (FICB), can be used to provide analgesia preoperatively.MethodsSystematic searches of all related literature were conducted in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Randomized controlled trials (RCTs) of proximal femoral fractures were included. The pain scores at different time points, opioid requirement in 24 h, mean arterial pressure, time for spinal anesthesia, patient satisfaction, and incidence of side effects between the 2 groups were extracted throughout the study.ResultsFifteen RCTs including 1240 patients met the inclusion criteria. The present meta-analysis indicated that compared with FNB, FICB could decrease the visual analog scale (VAS) scores at 4 h after surgery (P < .05). The incidence of side effects (nausea, vomiting, and sedation) was lower in the FNB group (P < .05). Compared to the FICB, no significant difference was found at any other observed time point. Additionally, no difference was found in opioid requirement at 24 h, mean arterial pressure, time for spinal anesthesia, or patient satisfaction (P > .05).ConclusionsFICB demonstrates a reduction in VAS score at 4 while FNB decreases the risk of several adverse events. More high-quality RCTs are necessary for proper comparison of the efficacy and safety of FNB and FICB.

Comparison of adductor canal block and femoral nerve block for pain management in anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials.

Objective:To compare the efficacy of adductor canal block and femoral nerve block for pain management in patients with anterior cruciate ligament reconstruction.Methods:A computerized search was performed in the database of PubMed, Embase, Web of Science and Cochrane Library for randomized controlled trials. The outcome measures included visual analog scale, morphine consumption, quadriceps strength, length of hospitalization and postoperative adverse events. The risk of bias of randomized controlled trials was assessed according to the Cochrane Risk of Bias Tool. All quantitative syntheses were completed using STATA version 14.Results:Seven randomized controlled trials involving a total of 643 patients were included in our meta-analysis. The present meta-analysis indicated that there were no significant differences between the 2 groups in terms of postoperative pain score, opioid consumption, length of hospitalization or adverse effects after anterior cruciate ligament reconstruction. However, adductor canal block showed superior quadriceps strength and range of motion in the early postoperative period.Conclusion:Adductor canal block shows similar and adequate analgesia compared to the femoral nerve block in anterior cruciate ligament reconstruction and adductor canal block can preserve a higher quadriceps strength and better range of motion.

Comparative evaluation of the use of femoral nerve block and adductor canal as a component of early patient activation after knee arthroplasty

BACKGROUND: The number of surgical interventions for the knee joint increases annually due the increase in the total number of patients and the improvement of operation techniques. The provision of modern anesthesiology and intensive care is associated with a positive treatment outcome, which is based on adequate pain relief in the perioperative period, suppressed complications, and reduction in hospital stay. Regional analgesia is a modern and effective method of pain relief after knee surgery. However, the location of peripheral blockade may affect the timing of activation and rehabilitation in these patients.&#x0D; AIM: This study aimed to evaluate the use of femoral nerve and adductor canal blockade in the framework of the accelerated recovery program after knee arthroplasty.&#x0D; MATERIALS AND METHODS: A prospective, randomized, single-center study included 80 patients who underwent primary knee arthroplasty and were randomly assigned to two clinical groups. Group 1 (n=40) included patients who underwent femoral nerve blockade in the postoperative period, and group 2 (n=40) included patients who underwent adductor canal blockade in the postoperative period. In the postoperative period, the level of pain at rest and during movement was analyzed using a visual analog pain level scale after 6, 12, 24, and 48 hours. The amount of prescribed narcotic analgesic in the postoperative period was recorded, and the total distance that patients were able to walk after 6, 12, 24, and 48 hours was measured.&#x0D; RESULTS: For the level of pain at rest and during movement, no significant differences at all time intervals were observed for both groups (p 0.05). No additional prescription of narcotic analgesics was required. Compared with group 1, group 2 covered a significantly greater distance in the first 24 after the operation. After 48 hours, no significant differences were found between the two groups (p 0.05).&#x0D; CONCLUSIONS: Femoral nerve and adductor canal blockades provide an adequate level of analgesia after knee arthroplasty. In particular, adductor canal blockade significantly increase the distance of movement by patients in the first 24 hours after surgery.

COMPARISION OF LANDMARK GUIDED FEMORAL NERVE BLOCK AND SYSTEMIC INTRAVENOUS ANALGESIA FOR PAIN RELIEF IN TRAUMATIC SHAFT FEMUR FRACTURE.

Background: Femoral nerve block is useful technique for acute pain relief in case of fracture shaft femur in comparison to systemic analgesia. a) To study and compare whether femoral nerve block is more efficaciousAims and Objective: in pain management of femoral shaft fractures than systemic intravenous analgesia. b) To study the duration of action of femoral nerve block for pain relief in femoral shaft fractures. c) To notify any complication. 60Materials and Methods: patients of ASA I and II, aged 20-60 years, having fracture traumatic shaft femur at either level (mid, upper, lower) were studied after admission of patient in emergency ward. They were randomly allocated to group A (n-30, femoral nerve block using 15 ml 2% Lignocaine) and group B (n-30, systemic analgesia using Inj. Paracetamol 1 gm). Each case was subsequently followed up for onset and total duration of analgesia till 6 hrs. Efficacy in both groups was assessed by visual analogue scale. There is no significant difference in onset of action between both theResults and Summary: groups. The duration of action in group A was more (4.08±1.06 hours) than group B (2.18±1.24hours). Visual analogue score showed significant pain reduction in group A after 15 minutes and also at 180 minutes (p=0.000) in comparison with group B. femoral nerve block is safe, simple and more efficacious procedure in comparison toConclusion: systemic IV analgesia for acute pain management in patients with fracture shaft femur.