Intervention Review

Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures

  1. Martyn J Parker1,*,
  2. Richard Griffiths2,
  3. Bal Appadu2

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 21 JAN 2002

Assessed as up-to-date: 13 OCT 2008

DOI: 10.1002/14651858.CD001159

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.

Author Information

  1. 1

    Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough, Cambridgeshire, UK

  2. 2

    Peterborough and Stamford Hospitals NHS Foundation Trust, Department of Anaesthesia, Peterborough, Cambridgeshire, UK

*Martyn J Parker, Orthopaedic Department, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, PE3 6DA, UK. martyn.parker@pbh-tr.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 21 JAN 2002

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Various nerve blocks using local anaesthetic agents have been used in order to reduce pain after hip fracture, and subsequent surgery.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

髖部骨折的神經阻斷術(肋下神經、股外側皮神經、股神經、三聯神經、腰神經)

為了減緩髖部骨折的疼痛,許多神經阻斷術使用局部麻醉劑來操作。

目標

神經阻斷術的效果評估(術前、術中、術後)是治療髖部骨折的一環。

搜尋策略

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。

選擇標準

把神經阻斷術當做照顧髖部骨折病人的隨機與半隨機試驗(trials)

資料收集與分析

利用九項評估指標,兩個回顧者(reviewer)獨立得到試驗的品質並擷取資料。在任何合適的地方,所得的結果都被儲存起來。

主要結論

這篇文章包含了八個隨機或半隨機的試驗,328個病人牽涉其中。其中三個為術前神經阻斷,剩下五個為術中神經阻斷。神經阻斷術減少了口服或靜脈注射的止痛藥用量。但是這樣的減少無法解釋任何臨床上的好處。

作者結論

由於這個回顧(review)包含的病人數太少,而且神經阻斷術用的方式與時間點也不同,與其他治療髖部骨折的麻醉方法比較起來,我們無法確定神經阻斷術能否帶來任何顯著的好處。進一步的試驗需要更多病人和更完整的臨床結果。

翻譯人

本摘要由臺灣大學附設醫院羅婉育翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

神經阻斷術似乎可以減輕髖部骨折術後的疼痛,但仍需更多的證據。在髖部骨折的病人,減緩疼痛可以由阻斷不同的神經來達到。這篇回顧發現這些試驗主要都是小型的,而且調查許多不同的神經阻斷術。神經阻斷術可以減少術後疼痛與止痛藥的使用已經是個共識。然而,這些試驗並未提供哪一條神經阻斷是最好的,有沒有其他臨床好處也仍是未知。