A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block

Szűcs, Szilárd; Morau, Didier; Sultan, Syed Farjad; Iohom, Gabriella; Shorten, George D.

A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block

dc.contributor.author	Szűcs, Szilárd
dc.contributor.author	Morau, Didier
dc.contributor.author	Sultan, Syed Farjad
dc.contributor.author	Iohom, Gabriella
dc.contributor.author	Shorten, George D.
dc.contributor.funder	Department of Anaesthesia, Intensive Care and Pain Medicine, Cork University Hospital
dc.contributor.funder	University College Cork
dc.contributor.funder
dc.date.accessioned	2016-02-04T15:07:24Z
dc.date.available	2016-02-04T15:07:24Z
dc.date.issued	2014-01-25
dc.description.abstract	Background: 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. Methods: 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. Results: 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. Conclusions: 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.	en
dc.description.status	Peer reviewed	en
dc.description.version	Published Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.articleid	6
dc.identifier.citation	SZŰCS, S., MORAU, D., SULTAN, S. F., IOHOM, G. & SHORTEN, G. 2014. A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block. BMC Anesthesiology, 14:6, 1-7. http://dx.doi.org/10.1186/1471-2253-14-6	en
dc.identifier.doi	10.1186/1471-2253-14-6
dc.identifier.endpage	7	en
dc.identifier.issn	1471-2253
dc.identifier.journaltitle	BMC Anesthesiology	en
dc.identifier.startpage	1	en
dc.identifier.uri	https://hdl.handle.net/10468/2255
dc.identifier.volume	14	en
dc.language.iso	en	en
dc.publisher	BioMed Central Ltd.	en
dc.rights	© Szűcs et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.	en
dc.rights.uri	http://creativecommons.org/licenses/by/2.0	en
dc.subject	Optimal positioning of the local anesthetic	en
dc.subject	Femoral nerve block	en
dc.title	A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block	en
dc.type	Article (peer-reviewed)	en