Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures
Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group
Published Online: 21 JAN 2002
Assessed as up-to-date: 13 OCT 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Parker MJ, Griffiths R, Appadu B. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD001159. DOI: 10.1002/14651858.CD001159.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 21 JAN 2002
Various nerve blocks using local anaesthetic agents have been used in order to reduce pain after hip fracture, and subsequent surgery.
To determine the effects of nerve blocks (inserted either pre-operatively, operatively or post-operatively) that may be used to relieve pain after a hip fracture.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2), MEDLINE (1966 to May Week 2 2008), EMBASE (1988 to 2008 Week 21), CINAHL (1982 to May Week 4 2008) and reference lists of relevant articles.
Randomised and quasi-randomised trials involving the use of nerve blocks as part of the care of a hip fracture patient.
Data collection and analysis
Two review authors independently assessed trials for inclusion, trial quality by use of a nine item scale and extracted data. Wherever appropriate, results of outcome measures were pooled.
Seventeen randomised or quasi-randomised trials involving 888, mainly elderly and female, participants were included. Nine trials related to insertion of a nerve block pre-operatively and eight to peri-operative insertion.
Nerve blocks resulted in statistically significant reductions in reported pain levels and in the quantity of parenteral or oral analgesia administered to control pain from the fracture or during surgery. There were few reported complications, none major, associated with nerve blocks. The limited data for other outcomes, such as medical complications and mortality, showed a general lack of differences between nerve block and control group participants. There were no notable adverse reactions or complications from the nerve blocks.
Because of the small number of participants included in this review, limitations in the measurement and reporting of outcomes and the differing types of nerve blocks and timing of insertion, it is not possible to determine if nerve blocks confer any significant clinical benefit when compared with other analgesic methods as part of the treatment of a hip fracture. They do, however, reduce the degree of pain experienced by the patient from the hip fracture and subsequent surgery. Further randomised trials with larger numbers of participants and full reporting of clinical outcomes would be justified.
Plain language summary
Local anaesthetic nerve blocks for people with a hip fracture
To reduce pain after a hip fracture and subsequent surgery, various nerves may be blocked using local analgesics (pain killers). This review examined the evidence from randomised trials that evaluated the use of local anaesthetic nerve blocks for people with hip fractures. Seventeen trials, involving 888 mainly female and old people who had been admitted to hospital with hip fracture, were included in the review. In nine trials, nerve blocks were applied at the time of admission with the hip fracture, and in the other eight trials, application was at the time of surgery. Most studies were small with limited reporting of outcomes. Most studies found that a nerve block will reduce pain and the need for other painkillers for people with a hip fracture. There were few reported complications associated with nerve blocks. However, the available evidence is insufficient to determine whether nerve blocks have other clinical benefits and to what extent adverse effects may occur.
Nerve blocks do seem to reduce the pain after a hip fracture and hip fracture surgery, but more evidence is needed.
我們搜尋了考科藍肌肉骨骼傷害團(Cochrane Musculoskeletal Injuries Group)特殊註冊者(2001十月)、MEDLINE OVID WEB(1996 – 2001十月)、還有相關文章。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。