Published: 2017-07-26

Positioning for regional anesthesia in femur fracture surgeries: how effective is femoral nerve block? a randomised control study

Swetha Purohit, Sireesha Ejjapuredi, Ramachandra N. Badami


Background: Fracture of the femur is a common orthopaedic problem following trauma in patients of all ages. This study was undertaken to evaluate the effectiveness of femoral nerve block (FNB) in positioning the patients for regional anesthesia.

Methods: 100 patients between the ages 18 to 80 years, of ASA grade I, II and III, scheduled for elective surgeries of femur fracture were evaluated in 2 groups. Group FNB (n=50) received femoral nerve block with 15ml of 1.5% lignocaine and Group. Non FNB (n=50) was not given any block. Assessment of pain was carried out using visual analog scale (VAS). This was rated before, during and after the procedure of positioning for spinal/combined spinal epidural anesthesia (CSE). Vital parameters were tabulated.

Results: VAS scores were noted at 0, 2, 5,10,15 minutes and at the time of positioning. VAS scores at 15 minutes after FNB was 1.473 ±0.1639 and 8.250±0.3615 in patients without FNB. Time taken for CSE was significantly less in FNB group (13.026±0.4628) minutes as compared to non FNB group (19.660 ±0.3742) minutes. Patient satisfaction scores were significantly higher in FNB group (45/50) 1.4952±0.033 as compared to non FNB group (10/50) 0.3460±0.1786. Quality of patient positioning was better in FNB group (2.782 ±0.1273) as compared to non FNB (1.382±0.2473).

Conclusions:This study concludes that FNB is highly effective in giving good pain relief for positioning for regional anaesthetic procedures improving performance time and offers higher acceptance among patients with femoral fractures.



Combined spinal epidural, Femoral nerve block, Fracture femur, Positioning

Full Text:



Bhosle P, Prakash A, Aphale S. Femoral nerve block for positioning during regional anaesthesia in patients with fracture femur: a randomized controlled study. J Med Dental Sci Res. 2015;2(11):04-6.

Barriot P, Riou B, Ronchi L, Bellaiche S. Femoral nerve block in prehospital management of fractured shaft of femur. JEUR. 1988;1:21-4.

Jadon A, Kedia SK, Dixit S, Chakraborty S. Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture. Indian J Anaesth. 2014;58:705-8.

Sia S, Pelusio F, Barbagli R, Rivituso C. Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl. Anesth Analg. 2004;99:1221‑4.

Mosaffa F, Esmaelijah A, Khoshnevis H. Analgesia before performing a spinal block in the lateral decubitus position in patients with femoral neck fracture: A comparison between fascia iliac block and IV fentanyl. Reg Anesth Pain Med. 2005;30(1):61.

Yun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH. Analgesia before a spinal block for femoral neck fracture: fascia iliac compartment block. Acta Anaesthesiol Scand. 2009;53:1282-7.

Lopez S, Gros T, Bernard N, Plasse C, Capdevila X. Fascia iliac compartment block for femoral bone fractures in prehospital care. Reg Anesth Pain Med. 2003;28:203-7.

Wathen JE, Gao D, Merritt G, Georgopoulos G, Battan FK. A randomized controlled trial comparing a fascia iliac compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department. Ann Emerg Med. 2007;50:162-71.

Bajwa SS, Kulshrestha A. Craniofacial and maxillary anomalies: Anesthetics implications and management. J Sci Soc. 2014;41:73‑8.

Chau DL, Walker V, Pai L, Cho LM. Opiates and elderly: use and side effects. Clin Interv Aging. 2008;3:273‑8.

Mutty CE, Jensen EJ, Manka MA, Anders MJ, Bone LB. Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department. Surgical technique. J Bone Joint Surg Am. 2008;90:218‑26.

Singh AP, Kohli V, Bajwa SJ. Intravenous analgesia with opioids versus femoral nerve block with 0.2% ropivacaine as pre-emptive analgesic for fracture femur: a randomized comparative study. Anesth Essays Res. 2016;10:338-42.

Pennington N, Gadd RJ, Green N, Loughenbury PR. A national survey of acute hospitals in England on their current practice in the use of femoral nerve blocks when splinting femoral fractures. Injury. 2012;43:843‑5.

Durrani H, Butt KJ, Khosa AH. Pain Relief during positioning for spinal anesthesia in patients with femoral fracture: a comparison between femoral nerve block and intravenous nalbuphine. PJMHS. 2013;7(4).

McEwen A. Anaesthesia Tutorial of the week 249, 6th February 2012. Available at www. davis drug .com

Sandby‑Thomas M, Sullivan G, Hall JE. A national survey into the peri‑operative anaesthetic management of patients presenting for surgical correction of a fractured neck of femur. Anaesthesia. 2008;63:250‑8.

Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2004;4(4).

Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta‑analysis of randomized trials. Br J Anaesth. 2000;84:450‑5.

Stanley I. The anaesthetic management of upper femoral fracture. Curr Anaesth Crit Care. 2005;16:23‑33.

Schiferer A, Gore C, Gorove L, Lang T, Steinlechner B, Zimpfer M, et al. A randomized controlled trial of femoral nerve blockade administered preclinically for pain relief in femoral trauma. Anesth Analg. 2007;105:1852‑4.

Szucs S, Iohom G, O’Donnell B, Sajgalik P, Ahmad I, Salah N, et al. Analgesic efficacy of continuous femoral nerve block commenced prior to operative fixation of fractured neck of femur. Perioper Med. 2012;1:4.

Iamaroon A, Raksakietisak M, Halilamien P, Hongsawad J, Boonsararuxsapong K. Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur. Local Reg Anesth. 2010;3:21‑6.

Urbanek B, Duma A, Kimberger O, Huber G, Marhofer P, Zimpfer M, et al. Onset, time, quality of blockade, and duration of three‑in‑one blocks with levobupivacaine and bupivacaine. Anesth Analg. 2003;97:888‑92.

Marhofer P, Oismuller C, Faryniak B, Sitzwohl C, Mayer N, Kapral S. Three‑in‑one blocks with ropivacaine: Evaluation of sensory onset time and quality of sensory block. Anesth Analg. 2000;90:125‑8.

Geier KO. Peripheral nerve stimulator for femoral nerve block. Is it really necessary? Rev Bras Anestesiol. 2003;53(3):338-45.

Khoo ST, Brown TC. Femoral nerve block-the anatomical basis for a single injection technique. Anaesthesia Intensive Care. 1983;11:40-2.