Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomized controlled trial

Rowlands, Martin; Walt, Gerrie van de; Bradley, Jim; Mannings, Alexa; Armstrong, Sarah; Bedforth, Nigel M.; Moppett, Iain K.; Sahota, Opinder

Abstract

Objective

Fractured neck of femur is a severely painful condition with significant mortality and morbidity. We investigated whether early and continuous use of femoral nerve block can improve pain on movement and mobility after surgery in older participants with fragility neck of femur fracture.

Design

Prospective single centre, randomised controlled pragmatic trial.

Setting

Secondary care, acute NHS Trust, UK.

Participants

Participants admitted with a history and examination suggesting fractured neck of femur.

Intervention

Immediate continuous femoral nerve block via catheter or standard analgesia.

Results

One hundred and forty one participants were recruited, with 23 excluded. No significant difference was detected between cumulative dynamic pain scores (standard care (n = 56) vs 4
intervention (n = 55) 20 (IQR 15-24) vs 20 (15-23) p=0.51) or cumulated ambulation scores (standard care vs intervention 6 (5-9) vs 7 (5-10) p=0.76). There were no statistically different differences in secondary outcomes except cumulative pain at rest: 5 (0.5-6.5) in the standard care group and 2 (0-5) in the intervention group (p=0.043).

Conclusions

Early application of continuous femoral nerve block compared with standard systemic analgesia did not result in improved dynamic pain scores or superior post-operative ambulation. This technique may provide superior pain relief at rest. Continuous femoral nerve block did not delay initial control of pain, or mobilisation after surgery.

Citation

Rowlands, M., Walt, G. V. D., Bradley, J., Mannings, A., Armstrong, S., Bedforth, N. M., Moppett, I. K., & Sahota, O. (2018). Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomized controlled trial. BMJ Open, 8(4), Article e019650. https://doi.org/10.1136/bmjopen-2017-019650

• Journal Article Type: Article
• Acceptance Date: Feb 2, 2018
• Publication Date: Apr 10, 2018
• Deposit Date: Mar 5, 2018
• Publicly Available Date: Apr 10, 2018
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 8
• Issue: 4
• Article Number: e019650
• DOI: https://doi.org/10.1136/bmjopen-2017-019650
• Keywords: Femoral nerve block; Hip fracture; Regional anaesthesia; Pain control; Older people
• Public URL: https://nottingham-repository.worktribe.com/output/924586
• Publisher URL: http://bmjopen.bmj.com/content/8/4/e019650
• Related Public URLs: https://creativecommons.org/licenses/by-nc/4.0/
• Contract Date: Mar 5, 2018