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Femoral Nerve Block for Diaphyseal and Distal Femoral Fractures in the Emergency Department

Surgical Technique

¹ Department of Orthopaedic Surgery, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157. E-mail address: cmutty{at}buffalo.edu
² Departments of Anesthesiology (E.J.J.), Emergency Medicine (M.A.M. Jr.), and Orthopaedic Surgery (M.J.A. and L.B.B.), Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215

Investigation performed at Erie County Medical Center, an affiliate of the State University of New York at Buffalo, Buffalo, New York

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 2599-603, December 2007

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

NOTE: The authors thank Mark Barnett and Van Sikes for their assistance with the preparation of the figures for this article.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

METHODS: Patients who presented with an acute diaphyseal or distal femoral fracture were identified as potential candidates for this study. Eligible patients were randomized by medical record number to receive either (a) the femoral nerve block (20 mL of 0.5% bupivacaine) along with standard pain management or (b) standard pain management alone (typically intravenous narcotics). The pain was assessed with use of a visual analog scale at the initial evaluation and at five, fifteen, thirty, sixty, and ninety minutes following the initial evaluation. Fifty-four patients were enrolled in the study from April 2005 to May 2006. Thirty-one patients received a femoral nerve block, and twenty-three patients received standard pain management alone.

RESULTS: Baseline scores on the visual analog pain scale did not differ between the groups at the initial evaluation. The patients who received a femoral nerve block (along with standard pain management) had significantly lower pain scores at five, fifteen, thirty, sixty, and ninety minutes following the block than did the patients who received standard pain management alone (p < 0.001). The score on the visual analog pain scale across these time points was an average of 3.6 points less (on a 10-point scale) for those who received the block. There were no infections, paresthesias, or other complications related to the femoral nerve block.

CONCLUSIONS: The acute pain of a diaphyseal or distal femoral fracture can be significantly decreased through the use of a femoral nerve block, which can be administered safely in the hospital emergency department.

LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Femoral Nerve Block for Diaphyseal and Distal Femoral Fractures in the Emergency Department" (2007;89:2599-603).

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