The analgesic benefit and safety of pre-hospital femoral nerve block compared with other, more common forms of pain-relief remains uncertain.

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• Lasse Raatiniemi, Vidar Magnusson, Per K Hyldmo, Kristian D Friesgaard, Poul Kongstad, Jouni Kurola, Robert Larsen, Marius Rehn, Leif Rognås, Mårten Sandberg, and Gunn E Vist.
• Centre for Prehospital Emergency Care, Oulu University Hospital, Oulu, Finland.
• Acta Anaesthesiol Scand. 2020 Sep 1; 64 (8): 1038-1047.

BackgroundPain management is one of the most important interventions in the emergency medical services. The femoral nerve block (FNB) is, among other things, indicated for pre- and post-operative pain management for patients with femoral fractures but its role in the pre-hospital setting has not been determined. The aim of this review was to assess the effect and safety of the FNB in comparison to other forms of analgesia (or no treatment) for managing acute lower extremity pain in adult patients in the pre-hospital setting.MethodsA systematic review (PROSPERO registration (CRD42018114399)) was conducted. The Cochrane and GRADE methods were used to assess outcomes. Two authors independently reviewed each study for eligibility, extracted the data and performed risk of bias assessments.ResultsFour studies with a total of 252 patients were included. Two RCTs (114 patients) showed that FNB may reduce pain more effectively than metamizole (mean difference 32 mm on a 100 mm VAS (95% CI 24 to 40)). One RCT (48 patients) compared the FNB with lidocaine and magnesium sulphate to FNB with lidocaine alone and was only included here for information regarding adverse effects. One case series included 90 patients. Few adverse events were reported in the included studies. The certainty of evidence was very low. We found no studies comparing FNB to inhaled analgesics, opioids or ketamine.ConclusionsEvidence regarding the effectiveness and adverse effects of pre-hospital FNB is limited. Studies comparing pre-hospital FNB to inhaled analgesics, opioids or ketamine are lacking.© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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