Klassov Y. Ultrasound guided femoral nerve blocks as a compulsory pain protocol in femoral neck fractures. World J Orthop 2025; 16(12): 102402 [DOI: 10.5312/wjo.v16.i12.102402]
Corresponding Author of This Article
Yuri Klassov, MD, Department of Orthopedic Surgery, Kantonsspital Baselland, Basel, Bruderholz 4101, Switzerland. yuriklassov@gmail.com
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Orthopedics
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Dec 17, 2025
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Publication Name
World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Klassov Y. Ultrasound guided femoral nerve blocks as a compulsory pain protocol in femoral neck fractures. World J Orthop 2025; 16(12): 102402 [DOI: 10.5312/wjo.v16.i12.102402]
World J Orthop. Dec 18, 2025; 16(12): 102402 Published online Dec 18, 2025. doi: 10.5312/wjo.v16.i12.102402
Ultrasound guided femoral nerve blocks as a compulsory pain protocol in femoral neck fractures
Yuri Klassov
Yuri Klassov, Department of Orthopedic Surgery, Kantonsspital Baselland, Bruderholz 4101, Switzerland
Yuri Klassov, Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva 4941492, Central, Israel
Author contributions: Klassov Y study conception and design; Klassov Y analysis and interpretation of results; Klassov Y draft manuscript preparation; Klassov Y reviewed the results and approved the final version of the manuscript.
Institutional review board statement: The study was approved by the SUMC Institutional Review Board Committee, reference number 0533–20-SOR. All clinical investigations were conducted according. to the principles expressed in the Declaration of Helsinki.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: I have no conflicts of interest to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All clinical investigations were conducted according. to the principles expressed in the Declaration of Helsinki. The Institutional Review Board approval exempted. the study from informed consent due to its retrospective design, which maintained. subject confidentiality. Patient records were anonymized and de-identified prior to analysis.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuri Klassov, MD, Department of Orthopedic Surgery, Kantonsspital Baselland, Basel, Bruderholz 4101, Switzerland. yuriklassov@gmail.com
Received: October 16, 2024 Revised: April 23, 2025 Accepted: November 14, 2025 Published online: December 18, 2025 Processing time: 426 Days and 22.4 Hours
Abstract
BACKGROUND
Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality. The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks (FNB) compared with patients treated with the standard analgesia protocol. The secondary objective was to find if there was a significant difference in morbidity between the two groups.
AIM
To evaluate the effectiveness of ultrasound (US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol. The study seeks to determine whether FNB offers superior outcomes in terms of pain control, rehospitalization rates, and mortality.
METHODS
This retrospective cohort study included 1577 patients suffering from neck femur fractures. 387 patients were treated with a FNB for pain management upon arrival at the emergency department, the rest were treated with standard analgesia. Pain was assessed from electronic medical records using the visual analogue scale (VAS) pre surgery, 12- and 24-hour post-surgery. To determine morbidity and mortality during hospitalizations and 6 months after, it was collected from electronic medical records.
RESULTS
In a cohort of 1577 patients, those receiving US-guided FNB had significantly lower preoperative VAS pain scores (1.46 ± 2.49 vs 1.82 ± 2.59, P = 0.001), reduced rehospitalization rates (0.99 ± 1.96 vs 1.46 ± 2.34, P < 0.001), and lower mortality (16% vs 32%, P < 0.001) compared to standard analgesia.
CONCLUSION
US guided FNB is more effective for pain management compared with standard analgesia. This method was also found to significantly reduce the risk of morbidity in those patients.
Core Tip: We found that ultrasound (US) guided femoral nerve block (FNB) is a safe and effective method to assist in pain management prior to surgery in hip fractures. This method is beneficial in decreasing the risk of morbidity in hip fracture patients as seen in lower rates of rehospitalizations and decreased mortality. We have learned that US guided FNB led to statistically significant lower pain levels prior to surgery compared with the group that received standard analgesia. We have learned that US guided FNB resulted in a statistically significant decrease in the risk of morbidity, specifically a decrease in rehospitalization and mortality 6 months post-surgery. In the future we need to continue to research this area regarding the issue of Being able to ascertain if delirium is decreased in patients undergoing US guided FNB for pain management and if patients had a reduced need for opioids.
