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Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

BACKGROUND: The evidence supporting the benefit of femoral nerve block (FNB) for positioning before spinal anesthesia (SA) in patients suffering from a femur fracture remains inconclusive. In the present study, the authors intended to determine the efficacy and safety of FNB versus an intravenous an...

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Autores principales: Hsu, Yuan-Pin, Hsu, Chin-Wang, Chu, Karen Chia Wen, Huang, Wen-Cheng, Bai, Chyi-Huey, Huang, Chun-Jen, Cheng, Sheng-Wei, Chen, Jin-Hua, Chen, Chiehfeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497313/
https://www.ncbi.nlm.nih.gov/pubmed/31048897
http://dx.doi.org/10.1371/journal.pone.0216337
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author Hsu, Yuan-Pin
Hsu, Chin-Wang
Chu, Karen Chia Wen
Huang, Wen-Cheng
Bai, Chyi-Huey
Huang, Chun-Jen
Cheng, Sheng-Wei
Chen, Jin-Hua
Chen, Chiehfeng
author_facet Hsu, Yuan-Pin
Hsu, Chin-Wang
Chu, Karen Chia Wen
Huang, Wen-Cheng
Bai, Chyi-Huey
Huang, Chun-Jen
Cheng, Sheng-Wei
Chen, Jin-Hua
Chen, Chiehfeng
author_sort Hsu, Yuan-Pin
collection PubMed
description BACKGROUND: The evidence supporting the benefit of femoral nerve block (FNB) for positioning before spinal anesthesia (SA) in patients suffering from a femur fracture remains inconclusive. In the present study, the authors intended to determine the efficacy and safety of FNB versus an intravenous analgesic (IVA) for positioning before SA in patients with a femur fracture. METHOD: PubMed, EMBASE, Cochrane, and Scopus databases were searched up to January 2018. We included randomized controlled studies (RCTs) and observational studies that compared FNB versus IVA for the positioning of patients with femur fracture receiving SA. The primary outcome was pain scores during positioning within 30 min before SA. Secondary outcomes were the time for SA, additional analgesic requirements, anesthesiologist’s satisfaction with the quality of positioning for SA, participant acceptance, and hemodynamic changes. A random-effects model was used to synthesize the data. We registered the study at PROSPERO with an ID of CRD42018091450. RESULTS: Ten studies with 584 patients were eligible for inclusion. FNB achieved significantly lower pain scores than IVA during positioning within 30 min before SA (pooled standardized mean deviation (SMD): -1.27, 95% confidence interval (CI): -1.84 to -0.70, p < 0.05). A subgroup analysis showed that the analgesic effect was larger in patients in the sitting position for SA than a non-sitting position (sitting position vs non-sitting: pooled SMD: -1.75 (p < 0.05) vs -0.61 (not significant). A multivariate regression showed that the analgesic effect was also associated with age and the total equivalent amount as lidocaine after adjusting for gender (age: coefficient 0.048, p < 0.05; total equivalent amount as lidocaine: coefficient 0.005, p < 0.05). Patients receiving FNB also had a significantly shorter time for SA, greater anesthesiologist satisfaction, and higher patient acceptance than patients receiving IVA. The use of local anesthetics did not produce significant clinical hemodynamic change. CONCLUSION: Compared to IVA, FNB was an effective and safe strategy for the positioning of femur fracture patients for a spinal block, particularly patients who received SA in the sitting position.
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spelling pubmed-64973132019-05-17 Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis Hsu, Yuan-Pin Hsu, Chin-Wang Chu, Karen Chia Wen Huang, Wen-Cheng Bai, Chyi-Huey Huang, Chun-Jen Cheng, Sheng-Wei Chen, Jin-Hua Chen, Chiehfeng PLoS One Research Article BACKGROUND: The evidence supporting the benefit of femoral nerve block (FNB) for positioning before spinal anesthesia (SA) in patients suffering from a femur fracture remains inconclusive. In the present study, the authors intended to determine the efficacy and safety of FNB versus an intravenous analgesic (IVA) for positioning before SA in patients with a femur fracture. METHOD: PubMed, EMBASE, Cochrane, and Scopus databases were searched up to January 2018. We included randomized controlled studies (RCTs) and observational studies that compared FNB versus IVA for the positioning of patients with femur fracture receiving SA. The primary outcome was pain scores during positioning within 30 min before SA. Secondary outcomes were the time for SA, additional analgesic requirements, anesthesiologist’s satisfaction with the quality of positioning for SA, participant acceptance, and hemodynamic changes. A random-effects model was used to synthesize the data. We registered the study at PROSPERO with an ID of CRD42018091450. RESULTS: Ten studies with 584 patients were eligible for inclusion. FNB achieved significantly lower pain scores than IVA during positioning within 30 min before SA (pooled standardized mean deviation (SMD): -1.27, 95% confidence interval (CI): -1.84 to -0.70, p < 0.05). A subgroup analysis showed that the analgesic effect was larger in patients in the sitting position for SA than a non-sitting position (sitting position vs non-sitting: pooled SMD: -1.75 (p < 0.05) vs -0.61 (not significant). A multivariate regression showed that the analgesic effect was also associated with age and the total equivalent amount as lidocaine after adjusting for gender (age: coefficient 0.048, p < 0.05; total equivalent amount as lidocaine: coefficient 0.005, p < 0.05). Patients receiving FNB also had a significantly shorter time for SA, greater anesthesiologist satisfaction, and higher patient acceptance than patients receiving IVA. The use of local anesthetics did not produce significant clinical hemodynamic change. CONCLUSION: Compared to IVA, FNB was an effective and safe strategy for the positioning of femur fracture patients for a spinal block, particularly patients who received SA in the sitting position. Public Library of Science 2019-05-02 /pmc/articles/PMC6497313/ /pubmed/31048897 http://dx.doi.org/10.1371/journal.pone.0216337 Text en © 2019 Hsu et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hsu, Yuan-Pin
Hsu, Chin-Wang
Chu, Karen Chia Wen
Huang, Wen-Cheng
Bai, Chyi-Huey
Huang, Chun-Jen
Cheng, Sheng-Wei
Chen, Jin-Hua
Chen, Chiehfeng
Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis
title Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis
title_full Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis
title_fullStr Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis
title_full_unstemmed Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis
title_short Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis
title_sort efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497313/
https://www.ncbi.nlm.nih.gov/pubmed/31048897
http://dx.doi.org/10.1371/journal.pone.0216337
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