BACKGROUND: Diaphyseal and distal femoral fractures are painful
injuries that are frequently seen in patients requiring a trauma work-up in
the hospital emergency department prior to definitive management. The purpose
of this study was to determine whether a femoral nerve block administered in
the emergency department could provide better pain relief for patients with
femoral fractures than currently used pain management practices.
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
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
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"