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Use of ultrasound to facilitate accurate femoral nerve block in the emergency department
Author(s) -
Reid Nicole,
Stella Julian,
Ryan Matt,
Ragg Michael
Publication year - 2009
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2009.01163.x
Subject(s) - medicine , femoral nerve block , femoral nerve , ultrasound , surgery , randomized controlled trial , emergency department , anesthesia , radiology , psychiatry
Objective: To compare the accuracy of ultrasound (US)‐assisted femoral nerve blocks (FNB) with the fascial pop (FP) technique, examining the rates of success and complications. Methods: This is a prospective unblinded pseudo‐randomized controlled trial of US‐assisted versus FP FNB techniques. The primary outcome measure was nerve block stratified to level of blockade (intact, partial or complete) with FNB assessed by skin sensation. Participants were assessed at 15 and 60 min post nerve block. Results: Sixty‐seven patients were enrolled. Thirty‐four (50.7% [95% CI 44.7–56.8]) underwent the US‐assisted technique whereas thirty‐three (49.2% [95% CI 43.4–55.2]) underwent the FP technique. At 15 min, FNB using US was intact, partial or complete for 9 (26.5% [95% CI 22.5–30.4]), 15 (44.1% [95% CI 36.8–51.5]) and 10 (29.4% [95% CI 24.9–33.9]) patients, respectively, compared with 14 (42.4% [95% CI 35.3–49.6]), 17 (51.5% [95% CI 42.7–60.3]) and 2 (6.1% [95% CI 5.6–6.6]) patients, respectively ( P = 0.038). There was no difference at 60 min. Complete block at 15 min was achieved in 10/34 patients (29% [95% CI 14.1–44.7]) in the US group and 2/33 patients (6% [95% CI −2.1–14.2]) in the FP group ( P = 0.029); no difference was seen at 60 min. No complications were recorded in either group. Conclusions: A more complete blockade is achieved earlier using the US‐assisted technique. The US‐assisted technique will become the technique of choice for FNB in this department.