Femoral nerve block vs IV fentanyl for hip fracture pain in the emergency department: A randomized double-blind clinical trial
Abstract
BACKGROUND
Hip fractures frequently cause severe pain and functional decline in adults presenting to emergency departments (EDs). Although intravenous (IV) opioids are widely used for pain control, their use may be limited by adverse effects, especially in patients with comorbidities or cognitive impairment. Ultrasound-guided femoral nerve block (FNB) offers a regional analgesic technique that may provide effective pain relief while reducing opioid-related complications. However, comparative randomized trials in the ED setting remain limited.
METHODS
In this single-center, randomized, double-blind clinical trial, adult patients with radiologically confirmed hip fractures were assigned to receive either ultrasound-guided FNB (20 mL 0.5 % bupivacaine) or IV fentanyl (1 μg/kg). To preserve blinding, patients in each group received a placebo injection mimicking the alternative treatment. Pain severity was measured at baseline and 20 min post-intervention using the Numeric Pain Rating Scale or the Pain Assessment in Advanced Dementia Scale (PAINAD), based on cognitive status. The primary outcome was change in pain score at 20 min. Secondary outcomes included rescue analgesia requirement within four hours and adverse events.
RESULTS
A total of 104 patients were enrolled and randomized. The FNB group experienced greater median pain reduction compared to the fentanyl group (4 [IQR 3-5] vs. 2 [IQR 2-3]; median difference: 2, 95 % CI: 1-2). Rescue analgesia was required in 21.1 % of…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 104 participants or records.
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