Two Femoral Nerve Block Techniques Compared for Patients with Femur Fractures

Published in Emerg Med J 2014 Nov 27

Authors: Reavley P et al.

The fascia iliaca and 3-in-1 femoral nerve blocks were equally effective for reducing pain from femoral neck fractures.

Both the 3-in-1 block and fascia iliaca block (FIB) provide effective analgesia for patients with femoral neck fractures; however, they have never been directly compared in the emergency department setting. To test this, researchers in the U.K. randomized 178 adult patients to either approach. The 3-in-1 block was performed using either ultrasound-guidance or nerve stimulation; the FIB was performed using the anatomic landmark technique.

On the basis of a 100-point visual analog scale, pain scores for the 3-in-1 and FIB were similar at 30 minutes (45 and 44, respectively) and 60 minutes (35 and 38) after block delivery. Preoperative analgesia use was also similar between groups. Hospital length of stay was longer in the FIB group (14 vs. 10 days).

Comment
The 3-in-1 and fascia iliaca nerve block techniques are equally effective for reducing pain caused by femoral neck fractures. Other research has shown that both approaches improve pain control in pediatric and adult patients with femur fractures; in the elderly they can reduce the incidence of delirium, which is associated with higher mortality rates. These blocks are useful when trying to minimize the use of narcotic medications and in patients who have refractory pain.