• anesthesia
• block
• bupivacaine
• femoral
• lignocaine
• nerve block
• orthopedic

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.

• Orthopedic surgery
• Regional anesthesia
• Spinal
• Epidural
• Combined spinal epidural
• Peripheral nerve blocks
• Neuraxial blocks
• Upper extremity
• Lower extremity
• Interscalene
• Supraclavicular
• Infraclavicular
• Axillary
• Femoral
• Fascia iliaca
• Popliteal
• Sciatic
• Saphenous
• Adductor canal
• Lumbar plexus
• Brachial plexus
• Ankle
• iPACK
• Complication
• Local anesthetic systemic toxicity
• Nerve injury
• Block failure
• Continuous nerve block catheters

Femur fracture causes excruciating pain and surgical repair is recommended. To obtain satisfactory patient co-operation in the perioperative period, various analgesics have been used. Femoral nerve block (FNB) provides an excellent alternative for analgesia in the perioperative period. Dexmedetomidine of up to 2 μg.kg⁻¹ has been used in FNB as adjuvants in lower limb surgeries.

The aim was to study the effect of addition of Dexmedetomidine to Bupivacaine in FNB on the comfort of positioning for subarachnoid block (SAB) and postoperative analgesia.

Prospective, randomized, double-blind design was followed. Seventy American Society of Anesthesiologist I and II patients aged 18–70 years of either gender were randomly allocated into Group B (20 mL 0.25% Bupivacaine + 2 mL Normal Saline) and Group BD (received 20 mL 0.25% Bupivacaine + Dexmedetomidine 2 μg.kg⁻¹ diluted to 2 mL) for FNB. Numerical rating scale (NRS) was recorded before and after FNB and comfort of positioning graded. After 10 min, subarachnoid block (SAB) was administered. NRS was recorded postoperatively until 24 h.

The comfort of positioning improved in both the groups after FNB but was statistically not significant when compared among the groups (P = 0.7). Duration of postoperative analgesia was significantly higher in the Group BD (741 min ± 97 min) compared to the Group B (440 min ± 45 min) (P = 0.001) and was statistically significant.

FNB improved the comfort of positioning for SAB, but the addition of Dexmedetomidine did not have any added advantages with respect to comfort of positioning. However, the addition of Dexmedetomidine significantly increased the duration of postoperative analgesia with minimal hemodynamic changes.

• Femoral shaft fracture
• Femur fracture
• Opioid consumption
• Opioid demand
• Regional anesthesia
• Trauma

• Analgesia
• Blocks
• Emergency Department
• Hip Fracture
• Pain
• Preoperative
• Regional Anesthesia

Femoral fracture is the most painful bone injury and performing spinal anesthesia is extremely challenging due to very poor positioning unless we have a very good mode of analgesia. Intravenous strong opioids are commonly used but to date nerve blocks are also being utilized. The reliability and effectiveness of the aforementioned methods are not conclusive to practice worldwide. The objective of the study was to compare the analgesic effect of intravenous fentanyl, femoral nerve block (FNB) and fascia iliaca block (FICB) during positioning patients with femoral fracture for spinal anesthesia.

A randomized controlled trial study was conducted on 72 elective adult patients with femoral fracture aged 18–65 years and ASA I and II those were allocated randomly into three groups. The intravenous fentanyl (IVFE) group received 1µg/kg IV fentanyl, FNB group received nerve stimulator guided FNB with 30 mL of 1% lidocaine with adrenaline and FICB group received FICB with 30 mL of 1% lidocaine with adrenaline. Pain intensity in numeric rating score (NRS), time to perform spinal anesthesia, quality of positioning and patient acceptance were assessed. SPSS version 26 and Kruskal–Wallis test were used to analyze data and p value <0.05 was considered significant.

NRS Pain score during positioning was significantly lower in FNB and FICB groups than IVFE group [median (IQR)]; 2 (1–2.5), 2 (2–3)) vs. 3 (3–4) respectively; P<0.001 and P=0.001. However, FNB and FICB groups were not significantly different with (P=1.000). Time to perform spinal anesthesia was significantly longer in IVFE group 9.5 (9–10) minutes than both FNB and FICB groups 7 (6–8), 8 (6–8) respectively, P<0.001. The quality of positioning was significantly lower in the IVFE group than both FNB and FICB groups (P<0.001).

Preoperative FNB and FICB reduce pain score during positioning, shorten time to perform spinal anesthesia, better patient positioning and higher patient acceptance in a patient undergoing elective femoral bone fracture surgery.

Pan African Clinical Trial Registry, PACTR202006669166858, registered on June 19, 2020. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12127.

• fascia iliaca block; FICB
• femoral fracture
• femoral nerve block; FNB
• intravenous fentanyl
• spinal anesthesia positioning

• Aged
• Aged, 80 and over
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/adverse effects
• Confusion/epidemiology
• Confusion/prevention & control
• Early Ambulation
• Female
• Hip Fractures/mortality
• Hip Fractures/surgery
• Humans
• Male
• Middle Aged
• Movement
• Myocardial Infarction/epidemiology
• Nerve Block/adverse effects
• Nerve Block/methods
• Pain Management
• Pain Measurement
• Pain, Postoperative/therapy
• Peripheral Nerves
• Pneumonia/epidemiology
• Randomized Controlled Trials as Topic
• Respiratory Tract Infections/prevention & control
• Time Factors

Patients with femoral neck fractures often suffer severe pain. This randomized controlled clinical study compared the effect of femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in this population.

Forty-six patients were randomly assigned to one of the two groups: FNB group (femoral nerve block, n=23) or FICB group (fascia iliaca compartment block, n=23). Before positioning for spinal anesthesia, patients received FNB with 15 mL of 0.5% ropivacaine or FICB with 40 mL of 0.5% ropivacaine. Pain was evaluated using a visual analogue scale (VAS) at rest and during hip flexion after admission to the operation room; at 3, 5, 8, and 10 min after analgesia intervention; and during positioning for spinal anesthesia. Positioning was attempted after 10 min of analgesia intervention in each group. Time required to perform spinal anesthesia, quality of positioning, and patient satisfaction were documented.

The VAS scores in the FNB group were significantly lower than those in FICB group at 3 and 5 min after analgesia intervention (P=0.000). However, there were no significant differences in VAS between groups at 8 or 10 min or during positioning.

FNB and FICB produce similar analgesic effects in patients with femoral neck fractures, but FNB has a more rapid onset of pain relief.

• analgesia
• fascia iliaca compartment block
• femoral neck fracture
• femoral nerve block

• analgesia
• dexmedetomidine
• fentanyl
• ketamine
• spinal anesthesia

• Aged
• Aged, 80 and over
• Analgesia/methods
• Analgesics/administration & dosage
• Anesthesia, Spinal
• Dexmedetomidine/administration & dosage
• Double-Blind Method
• Female
• Fentanyl/administration & dosage
• Hip Fractures/surgery
• Humans
• Ketamine/administration & dosage
• Male
• Patient Positioning

• Analgesics
• Anesthesia, Spinal
• Bone
• Bupivacaine
• Fascia
• Femoral Nerve
• Fractures
• Nerve Block
• Pain Management
• Ultrasonography

The evidence supporting the benefit of femoral nerve block (FNB) for positioning before spinal anesthesia (SA) in patients suffering from a femur fracture remains inconclusive. In the present study, the authors intended to determine the efficacy and safety of FNB versus an intravenous analgesic (IVA) for positioning before SA in patients with a femur fracture.

PubMed, EMBASE, Cochrane, and Scopus databases were searched up to January 2018. We included randomized controlled studies (RCTs) and observational studies that compared FNB versus IVA for the positioning of patients with femur fracture receiving SA. The primary outcome was pain scores during positioning within 30 min before SA. Secondary outcomes were the time for SA, additional analgesic requirements, anesthesiologist’s satisfaction with the quality of positioning for SA, participant acceptance, and hemodynamic changes. A random-effects model was used to synthesize the data. We registered the study at PROSPERO with an ID of CRD42018091450.

Ten studies with 584 patients were eligible for inclusion. FNB achieved significantly lower pain scores than IVA during positioning within 30 min before SA (pooled standardized mean deviation (SMD): -1.27, 95% confidence interval (CI): -1.84 to -0.70, p < 0.05). A subgroup analysis showed that the analgesic effect was larger in patients in the sitting position for SA than a non-sitting position (sitting position vs non-sitting: pooled SMD: -1.75 (p < 0.05) vs -0.61 (not significant). A multivariate regression showed that the analgesic effect was also associated with age and the total equivalent amount as lidocaine after adjusting for gender (age: coefficient 0.048, p < 0.05; total equivalent amount as lidocaine: coefficient 0.005, p < 0.05). Patients receiving FNB also had a significantly shorter time for SA, greater anesthesiologist satisfaction, and higher patient acceptance than patients receiving IVA. The use of local anesthetics did not produce significant clinical hemodynamic change.

Compared to IVA, FNB was an effective and safe strategy for the positioning of femur fracture patients for a spinal block, particularly patients who received SA in the sitting position.

• Analgesics/therapeutic use
• Anesthesia, Spinal
• Female
• Femoral Fractures/therapy
• Femoral Nerve
• Humans
• Lidocaine/therapeutic use
• Male
• Nerve Block

• Taipei Medical University

• Neuraxial block
• Peripheral nerve block
• Regional anesthesia
• Trauma
• Trauma analgesia
• Trauma pain

• Acute Disease
• Anesthesia, Conduction/methods
• Emergency Medical Services
• Emergency Service, Hospital
• Humans
• Nerve Block/methods
• Perioperative Care
• Wounds and Injuries/therapy

• Aged
• Aged, 80 and over
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/adverse effects
• Confusion/epidemiology
• Female
• Hip Fractures/mortality
• Hip Fractures/surgery
• Humans
• Male
• Movement
• Myocardial Infarction/epidemiology
• Nerve Block/adverse effects
• Nerve Block/methods
• Pain Management
• Pain Measurement
• Pain, Postoperative/therapy
• Peripheral Nerves
• Pneumonia/epidemiology
• Randomized Controlled Trials as Topic
• Time Factors

• Analgesia
• Bloqueio do nervo femoral
• Femoral nerve block
• Fentanil
• Fentanyl
• Fraturas de quadril
• Hip fractures

• Anesthesia spinal
• Fascia iliaca block
• Femoral fractures
• Fentanyl

• Ropivacaine
• Sensory blockade
• Systemic analgesia

• Analgesia
• Bloqueio do nervo femoral
• Femoral nerve block
• Fentanil
• Fentanyl
• Fraturas de quadril
• Hip fractures

• Anaesthesia
• femoral nerve block
• femur fracture
• fentanyl
• position for spinal
• spinal

Fractured neck of femur generally requires operative fixation and is a common cause of admission to hospital. The combination of femoral nerve block and spinal anesthesia is a common anesthetic technique used to facilitate the surgical procedure. The optimal disposition of local anesthetic (LA) relative the femoral nerve (FN) has not been defined. Our hypothesis was: that the deposition of LA relative to the FN influences the quality of analgesia for positioning of the patient for performance of spinal anesthesia. The primary outcome was verbal rating (VRS) pain scores 0–10 assessed immediately after positioning the patient to perform spinal anesthesia.

With Institutional ethical approval and having obtained written informed consent from each, 52 patients were studied. The study was registered with ClinicalTrials.gov (NCT01527812). Patients were randomly allocated to undergo to one of three groups namely: intention to deposit lidocaine 2% (15 ml) i. above (Group A), ii. below (Group B), iii. circumferential (Group C) to the FN. A blinded observer assessed i. the sensory nerve block (cold) in the areas of the terminal branches of the FN and ii. VRS pain scores on passive movement from block completion at 5 minutes intervals for 30 minutes. Immediately after positioning the patient for spinal anesthesia, VRS pain scores were recorded.

Pain VRS scores during positioning were similar in the three groups [Above group/Below group/Circumferential group: 2(0–9)/0(0–10)/3(0–10), median(range), p:0.32]. The block was deemed to have failed in 20%, 47% and 12% in the Above group, Below group and Circumferential group respectively. The median number of needle passes was greater in the Circumferential group compared with the Above group (p:0.009). Patient satisfaction was greatest in the Circumferential group [mean satisfaction scores were 83.5(19.8)/88.1(20.5)/93.8(12.3), [mean(SD), p=0.04] in the Above, Below and Circumferential groups respectively.

We conclude that there is no clinical advantage to attempting to deposit LA circumferential to the femoral nerve (relative to depositing LA either above or below the nerve), during femoral nerve block in this setting.

• adolescent
• child
• child, preschool
• humans
• infant
• analgesia
• analgesia/methods
• analgesics, opioid
• analgesics, opioid/administration & dosage
• emergency medical services
• emergency medical services/methods
• fascia
• femoral fractures
• femoral fractures/complications
• femoral fractures/therapy
• femoral nerve
• morphine
• morphine/administration & dosage
• nerve block
• nerve block/methods
• pain management
• pain management/methods
• randomized controlled trials as topic

• Adolescent
• Analgesia/methods
• Analgesics, Opioid/administration & dosage
• Child
• Child, Preschool
• Emergency Medical Services/methods
• Fascia
• Femoral Fractures/complications
• Femoral Fractures/therapy
• Femoral Nerve
• Humans
• Infant
• Morphine/administration & dosage
• Nerve Block/methods
• Pain Management/methods
• Randomized Controlled Trials as Topic

• analgesia
• emergency
• geriatrics
• serum troponin T
• ultrasound-guided continuous 3-in-1 block

Fracture of femur is a painful bone injury, worsened by any movement. This prospective study was performed to compare the analgesic effects of femoral nerve block (FNB) with intravenous (IV) fentanyl prior to positioning patients with fractured femur for spinal block.

Sixty-four ASA I–III patients aged 18–80 years undergoing surgery for femur fracture were randomized into two groups. Fifteen minutes before spinal block, the FNB group received nerve stimulator-assisted FNB with a mixture of 20 mL bupivacaine 0.5% and 10 mL normal saline 0.9%, and the fentanyl group received two doses of IV fentanyl 0.5 μg/kg with a five-minute interval between doses. Numeric rating pain scores were compared. During positioning, fentanyl in 0.5 μg/kg increments was given every five minutes until pain scores were ≤4.

There were no statistically significant differences between the groups according to pain scores, need for additional fentanyl, and satisfaction with positioning before spinal block.

We were unable to demonstrate a benefit of FNB over IV fentanyl for patient positioning before spinal block. However, FNB can provide postoperative pain relief, whereas side effects of fentanyl must be considered, and analgesic dosing should be titrated based on pain scores. A multimodal approach (FNB + IV fentanyl) may be a possible option.

• bupivacaine
• femoral nerve block
• fentanyl
• pain on positioning

• Analgesia/methods
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/therapeutic use
• Arthroscopy
• Combined Modality Therapy
• Humans
• Injections, Intra-Articular
• Knee Joint/surgery
• Leg/surgery
• Pain, Postoperative/drug therapy
• Pain, Postoperative/therapy
• Physical Therapy Modalities
• Practice Guidelines as Topic

• Acute Disease
• Aged
• Aged, 80 and over
• Amides
• Analgesics, Opioid/therapeutic use
• Anesthetics, Local
• Catheterization
• Female
• Femoral Neck Fractures/complications
• Femoral Neck Fractures/surgery
• Femoral Nerve
• Humans
• Male
• Methimazole/therapeutic use
• Middle Aged
• Models, Organizational
• Naloxone/therapeutic use
• Narcotic Antagonists/therapeutic use
• Nerve Block/adverse effects
• Pain/drug therapy
• Pain/etiology
• Pain Measurement/drug effects
• Pain, Postoperative/drug therapy
• Prilocaine
• Prospective Studies
• Ropivacaine
• Tilidine/therapeutic use

• Ambulatory Surgical Procedures
• Anesthesia, Conduction/methods
• Anesthesia, Conduction/psychology
• Anesthesia, Conduction/standards
• Body Temperature
• Humans
• Hypnotics and Sedatives/pharmacokinetics
• Postoperative Care
• Practice Guidelines as Topic
• Preoperative Care/psychology
• Preoperative Care/standards
• Quality Assurance, Health Care/methods

• Anesthesia, Conduction
• Animals
• Humans
• Lower Extremity/injuries
• Pain/etiology
• Pain Management
• Upper Extremity/injuries
• Wounds and Injuries/therapy

• Aged
• Aged, 80 and over
• Anesthesia, Spinal/methods
• Blood Pressure
• Conscious Sedation
• Female
• Femoral Neck Fractures/diagnostic imaging
• Humans
• Hypnotics and Sedatives/administration & dosage
• Male
• Posture
• Propofol/administration & dosage
• Ultrasonography