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Meta-Analysis
. 2020 Sep;64(8):1038-1047.
doi: 10.1111/aas.13600. Epub 2020 Apr 24.

Femoral nerve blocks for the treatment of acute pre-hospital pain: A systematic review with meta-analysis

Lasse Raatiniemi  1   2 , Vidar Magnusson  3 , Per K Hyldmo  4   5   6 , Kristian D Friesgaard  7   8 , Poul Kongstad  9 , Jouni Kurola  10 , Robert Larsen  11 , Marius Rehn  4   5   12 , Leif Rognås  13   14   15 , Mårten Sandberg  12   16 , Gunn E Vist  17
Affiliations
Meta-Analysis

Femoral nerve blocks for the treatment of acute pre-hospital pain: A systematic review with meta-analysis

Lasse Raatiniemi et al. Acta Anaesthesiol Scand. 2020 Sep.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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References

REFERENCES

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