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Analgesia, sedation and emergency anaesthesia
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Femoral nerve block (Figure 15.1 and Box 15.1) is used for fractures of the femur and can significantly reduce the need for opiate anaesthesia and allow a pain-free reduction of fracture. The related fascia iliaca block provides improved analgesia specifically for fractured necks of femur but requires a specific needle and longer acting local anaesthetic and is probably best reserved for the emergency department.
Intracapsular proximal femoral fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Kjell Matre, Jan-Erik Gjertsen
In order to reduce morbidity, mortality and complications, and to facilitate rapid recovery, a collaborative multidisciplinary approach is essential.122–127 Femoral neck fractures should ideally be treated within 24 hours of presentation, and at latest within 48 hours after admission.126,128–130 Still, some patients need optimization before surgery can be performed.126 These patients should be assessed by experienced orthogeriatricians/physicians and anaesthesiologists prior to surgery. Delirium should be identified and treated, or even better, prevented where possible.131 No studies have proven any benefit from preoperative traction, and this should not be used.132 The preferred analgesics are paracetamol and additional opioids.126 A peripheral nerve blockade, such as a fascia iliaca block, may provide effective analgesia and thereby reduce the need for opioids.133
Continuous peripheral neural blockade for acute pain
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Kim E Russon, William Harrop-Griffiths
The original description of the three-in-one block claimed that local anesthetic injected into the femoral sheath just below the level of the inguinal ligament would spread proximally to provide blockade of the femoral, obturator, and lateral cutaneous nerves of the thigh.66 The increasing realization that blockade of the latter two nerves of this trio is produced by lateral rather than proximal spread of the local anesthetic has supported the use of subfascial blocks, such as the fascia iliaca block. Successful reports of the use of fascia iliaca catheters exist for both adults and children who undergo knee surgery.67, 68, 69 Continuous fascia iliaca blocks result in opioid-sparing and improved range of motion during the immediate postoperative period.68[II] Morau et al.69[II] showed that it may be faster to place a fascia iliaca catheter compared with a three-in-one catheter, but that there was no difference in pain relief or opioid requirements.
Procedural Sedation and Analgesia in Trauma Patients in an Out-of-Hospital Emergency Setting: A Prospective Multicenter Observational Study
Published in Prehospital Emergency Care, 2018
Michel Galinski, Laure Hoffman, Delphine Bregeaud, Mounir Kamboua, François-Xavier Ageron, Catherine Rouanet, Jean-Christophe Hubert, Jacques Istria, Mirko Ruscev, Karim Tazarourte, Florence Pevirieri, Frédéric Lapostolle, Frédéric Adnet
The purpose of procedural sedation and analgesia (PSA) in emergency medicine is to allow effective implementation of unpleasant procedures under conditions that meet the expectations of both patients and emergency medical services (EMS). The American College of Emergency Physicians defines PSA as “a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function” (1). The evidence underpinning the efficacy of the sedation methods recommended in guidelines and clinical policy statements is not contentious and the risks are well identified (2–4). In the prehospital emergency setting, such situations are frequent, particularly with trauma patients. Nevertheless, there is a minimal amount of data regarding the modalities used and their efficiency in this context. Many retrospective or prospective studies have evaluated pain prevalence in different situations and its management in trauma victims but did not specifically evaluate procedural pain (5–9). Studies have demonstrated the feasibility and the efficacy of the fascia-iliaca block for femoral fractures in a prehospital setting (10, 11). However, this cannot sum up the totality of procedural sedation-analgesia in the prehospital setting (10, 11).
Comparison between pericapsular nerve group block and morphine infusion in reducing pain of proximal femur fracture in the emergency department: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2023
Abdelrhman Alshawadfy, Ahmed M. Elewa, Mahmoud Ahmed Mewafy, Ahmed A. Ellilly
For the past 20 years, opioids have been dominating the global market for effective analgesia of hip fractures [15,16]. Opioids could reduce pain at rest, but they were ineffective in controlling pain on movement. Patients with hip fractures frequently employ fascia iliaca block and femoral nerve block for pain management because they are generally safe and can offer a reasonable level of analgesia with an opioid-sparing effect. However, these blocks might not offer enough analgesia in hip fractures. Pericapsular nerve group block is a novel approach with scarce scientific support [17]. The aim of this study was to assess the safety and efficacy of PENG block as an adjuvant to morphine for management of preoperative pain in patients with proximal femur fractures.
Surgical anesthesia for revision total hip arthroplasty with quadratus lumborum and fascia iliaca block
Published in Baylor University Medical Center Proceedings, 2019
Johanna Blair de Haan, Nadia Hernandez, Sophie Dean, Sudipta Sen
Patient frailty imposes a need for creativity among anesthesiologists caring for patients with complex medical comorbidities. It is important to have alternative methods of providing anesthesia than general anesthesia and neuraxial anesthesia, because a greater number of patients will have contraindications to both. Surgical anesthesia utilizing regional anesthesia is an ideal method if the necessary dermatomes and osteotomes are covered. Recent articles have demonstrated successful anesthesia for hip surgery using fascia iliaca block; deep sedation and analgesia with narcotics or infiltration of local anesthetic have also been required.1,2