Femoral Nerve Blockade May Reduce Need for Intravenous Opioids

Femur fractures often require surgical fixes and can be quite painful. Although traditionally treated with intravenous opioids, regional anesthesia may offer an alternative option.

In a new study, published in the Journal of Pain Research, researchers evaluated the efficacy of a regional anesthetic technique compared to intravenous opioids in treating pain following surgical repair of femur fractures in children. They found no significant differences between the two techniques on measures including postoperative pain scores and opioid requirements.

“Prior to four or five years ago, our general practice was to provide pain management to patients with femur fractures with opioids or narcotic pain medications,” says Nicole Elsey, MD, a physician on the anesthesiology and pain medicine team at Nationwide Children’s Hospital and one of the study’s authors.

More recently, Dr. Elsey and her colleagues have used a regional anesthetic technique called femoral nerve blockade in these patients.

“We found, anecdotally, that patients were doing better with regional anesthetic — fewer overall pain complaints, faster recovery and lower consumption of opioids,” says Tarun Bhalla, MD, a pediatric anesthesiologist at Nationwide Children’s, and an associate professor of anesthesiology at The Ohio State University College of Medicine.

To investigate these differences quantitatively, the team looked at a group of 17 pediatric patients undergoing surgical repair of a traumatic femur fracture. They assigned patients to one of two groups: general anesthesia with either a femoral nerve blockade or intravenous opioids.

Contrary to the team’s expectations, use of regional anesthetic did not significantly affect pain scores, intraoperative anesthetic requirements or postoperative opioid consumption.

There was a small, but not statistically significant, decrease in pain scores in the femoral nerve blockade group, suggesting a possible benefit to the technique. The small sample size, along with differences in age, mechanism and site of injury and initial post-injury care, could contribute to the lack of statistical differences between the two groups.

“Unfortunately, the study was difficult to perform given the various ways that femur fractures can be repaired,” says Dr. Elsey. “If we had a larger patient sample, we could narrow our scope to patients with the same type of femur fractures undergoing a specific type of fracture repair to try to determine what types of femur fractures benefit the most from regional nerve blocks.”

Although the study did not reveal any statistically significant benefits to femoral nerve blockades, the data suggest the technique is at least as effective as traditional pain management options. The team says that clinically, patients appear to benefit from regional anesthesia and it will continue to be an important treatment option.

“Even though we didn’t find statistical significance, we still provide regional nerve blocks to patients because, in this day and age, we take advantage of safe techniques that reduce the amount of opioids a patient receives,” says Dr. Bhalla.

Reference:

Elsey NM, Tobias JD, Klingele KE, Beltran RJ, Bhalla T, Martin D, Veneziano G, Rice J, Tumin D. A prospective, double-blinded, randomized comparison of ultrasound-guided femoral nerve block with lateral femoral cutaneous nerve block versus standard anesthetic management for pain control during and after traumatic femur fracture repair in the pediatric population. Journal of Pain Research. 2017;10:2177-2182.