| Authors (year) |
Setting |
Groups |
N |
Sample Size Justification |
Blinded Assessment |
Main Outcome |
Main Findings |
Technical Remarks |
| Chudinov et al. [34]
|
Ward Femoral neck fracture |
Intermittent LA boluses through a LP catheter (1-2 mg/kg of adrenalized bupivacaine 0.25% q 8 hours) vs. IM meperidine (1mg/kg q 5 hours) and diclofenac for breakthrough pain (1 mg/kg) |
40 |
N |
N |
? |
LP catheters: lower pain scores at 8 and 16 hours during the 48h-preoperative period. |
LOR used to identify the space between the quadratus lumborum and psoas muscles.
Blocks performed by anesthesiologists. |
| Luger et al. [37] |
ER Hip fracture in patients > 80 years |
Continuous 3-in-1 block (6 ml/h of bupivacaine 0.125%) vs. IV piritramide (0.05 mg/kg) and additional piritramide (3 mg SC) or paracetamol (1 g IV) for breakthrough pain |
20 |
Y |
Y |
Pain scores |
Lower dynamic pain scores and paracetamol consumption (0.1 ± 0.32 vs. 1.7 ± 1.4 mg/d; p < 0.05) with 3-in-1 block in the preoperative period.
Similar piritramide consumption in the preoperative period. |
3-in-1 block: US technique.
Success of 3-in-block assessed by testing sensory blockade of femoral, LFC and obturator nerves.
86.7% success rate for 3-in-1 block at 1 hour.
Blocks performed by anesthesiologists. |
| Graham et al. [36]
|
ED/ ward
Femoral neck fracture |
3-in-1 block vs.
IV morphine (0.1 mg/kg) |
33 |
N |
N |
Pain scores |
3-in-1 block: lower pain score at 30 minutes (p = 0.046).
No intergroup differences in pain scores at other measurement intervals during 12-hour assessment period.
No intergroup differences in 24-hour opioid consumption |
3-in-1 block: PNS technique.
Minimal stimulatory threshold not specified.
Blocks performed by ED physicians or trainees. |
| Fletcher et al. [35]
|
ED
Femoral neck fracture |
3-in-1 block vs.
IV morphine (5-10 mg hourly) |
50 |
Y |
Y |
Pain scores |
3-in-1 block: quicker time to lowest pain score (2.88 vs 5.81 hours)
and lower hourly morphine consumption (0.49 mg/h vs. 1.17 mg/h) during 24-hour study period. |
3-in-1 block:
EP technique.
Blocks performed by ED physicians. |
| Monzon et al. [38]
|
ED
Hip fracture |
FIB
vs.
IV NSAIDs |
154 |
Y |
Y |
Pain scores |
NSAIDs: lower pain scores at 15 minutes (6.24 ± 0.17 vs. 2.9 ± 0.16; p < 0.001).
No differences in pain at 2 and 8 hours. |
FIB: fascial click technique performed with 21-gauge “intramuscular injection” needle.
Performed by ED physicians. |
| Mouzopoulos et al. [39]
|
Ward
Hip fracture |
FIB: bupivacaine vs. NS |
207 |
N |
N |
Incidence of perioperative delirium in moderate and high risk patients |
FIB: lower incidence of (10.78 vs. 23.8%) and shorter duration (5.22 ±
4.28 vs. 10.97 ±
7.16 days) of delirium.
No differences in pain scores. |
Fascial click technique performed with a sharp 24-gauge needle.
FIB repeated every 24 hours.
Performed by orthopedic surgeons. |
| Foss et al. [40]
|
ED
Suspected hip fracture (prior to X ray exam) |
FIB
vs.
IM morphine (0.1
mg/kg) |
48 |
Y |
Y |
Pain scores |
FIB: superior analgesia at rest at 60 and 180 minutes (both p £ 0.03).
FIB: superior analgesia with 15 degree leg lift at 180 minutes (p = 0.04), decreased breakthrough IV morphine consumption (0 vs 6 mg: p < 0.01).
No differences in nausea/vomiting, sedation (p = 0.05), oxygen saturation (p = 0.08) and hemodynamics. |
Fascial click technique for FIB with a blunt 24-gauge needle.
FIB: 67% success at 30 minutes (absence of cold sensation on anterior and lateral thigh).
Performed by Anesthesiology residents. |
| Wathen et al. [41] |
ED
Children with femoral fracture (proximal, middle or distal) |
FIB
vs.
IV morphine |
55 |
Y |
N |
Pain scores |
FIB: lower pain scores during the 6 hours of the study, longer analgesia and less breakthrough analgesic requirement, and higher satisfaction from the medical staff. |
FIB performed with the fascial click technique using an 1-inch short beveled needle.
Blocks performed by ED physicians (with instruction by an anesthesiologist). |
| Barker et al. [45]
|
Accident site
Knee trauma |
Femoral block
vs.
IV metamizole (1 g) |
52 |
Y |
N |
Pain scores |
Femoral block:
decreased pain, anxiety and signs of vasoconstriction
during ambulance transport to hospital. |
Femoral block: PNS-guided technique (minimal stimulatory thresold = 0.3-0.4 mA; 0.1 ms).
Performed by ED physicians. |
| Mutty et al. [43]
|
ED
Diaphyseal and distal femoral fracture |
Femoral block vs.
IV hydromorphone |
54 |
Y |
N |
Pain scores |
Femoral block: lower pain scores at all measurement intervals (last assessment = 90 minutes after block). |
Femoral block: PNS technique but minimal stimulatory threshold not specified.
Performed by orthopedic residents. |
| Schiferer et al. [44]
|
Accident site
hip dislocation/
fracture,
femoral fracture,
patellar tendon rupture |
Femoral block
vs.
IV metamizole (1 g) |
62 |
Y |
N |
Pain scores |
Femoral block:
decreased pain, anxiety and heart rate between the on-site and transport values (both p < 0.001). |
Femoral block: PNS-guided technique (minimal stimulatory thresold = 0.3-0.4 mA; 0.1 ms).
Performed by ED physicians. |
| Haddad and Williams [42]
|
Ward
Extracapsular femoral neck fracture |
Femoral block vs. PO co-dydramol/ IM pethidine/ IM diclofenac |
50 |
N |
N |
? |
Femoral block: decreased pain at 15 minutes and 2 as well as lower requirements of IM opioids. |
Femoral nerve located with double click technique and EP.
Block performed by orthopedic residents. |
ED = Emergency Department; EP = elicitation of paresthesia; FIB = fascia iliaca block; IM = intramuscular; IV = intravenous; LA = local anesthetic; LOR = loss of resistance;
LP = lumbar plexus; N = no; NSAIDs = non-steroidal anti-inflammatory drugs; PNS = peripheral nerve stimulation; PO = per os; US = ultrasonography; Y = yes.