Impact of preoperative continuous femoral blockades on morphine consumption and morphine side effects in hip-fracture patients: A randomized, placebo-controlled study

TitreImpact of preoperative continuous femoral blockades on morphine consumption and morphine side effects in hip-fracture patients: A randomized, placebo-controlled study
Type de publicationArticle de revue
AuteurChaudet, Aurélie, Bouhours, Guillaume, Rineau, Emmanuel , Hamel, Jean-François, Leblanc, Damien, Steiger, Vincent, Lasocki, Sigismond
EditeurElsevier
TypeArticle scientifique dans une revue à comité de lecture
Année2016
LangueAnglais
DateFévrier 2016
Numéro1
Pagination37-43
Volume35
Titre de la revueAnaesthesia Critical Care & Pain Medicine
ISSN23525568
Mots-clésFemoral blockade, hip fracture, Opioid, Pain, Side effects
Résumé en anglais

Background

Upon arrival at the emergency department, hip-fracture pain relief is usually carried out via systemic opioids. Continuous nerve blocks are efficient in the postoperative period, but have not been evaluated preoperatively. This study compared the reduction in morphine consumption and related side effects of a continuous femoral block with a single shot block in hip-fracture patients.

Methods

Hip-fracture patients admitted to the emergency department received a femoral nerve catheter, with a single lidocaine injection. They were then randomized to ropivacaine (group R) or saline continuous infusion (placebo, group P) in a double-blind manner. Morphine consumption and side effects were prospectively collected until the 24th postoperative hour.

Results

Sixty patients were included and 55 analyzed. There were no significant differences between the 2 groups regarding fracture types, delay before surgery (median [Q1–Q3]: 21.3 [14.5–29.4] versus 20.8 [15.7–36.2] hours for groups R and P, respectively; P = 0.87) and catheter duration (47.5 [39.8–52.4] versus 42.5 [32.1–50.5] hours, P = 0.29). Total morphine consumption was not significantly decreased in group R (5 [0–14] versus 8 [4.5–11] mg, P = 0.3) and pain scores were similar (mean ± SD; VAS 29 ± 15/100 versus 33 ± 13, P = 0.3). We observed a significant reduction in morphine adverse effects (31% versus 69% for groups R and P, respectively; P < 0.01), mainly nausea (31% versus 59%, P = 0.03). One morphine side effect could be avoided for every 5 patients treated.

Conclusion

Preoperative continuous femoral blockades using ropivacaine reduce morphine side effects (mainly nausea) in hip-fracture patients without reducing morphine consumption.

URL de la noticehttp://okina.univ-angers.fr/publications/ua18452
DOI10.1016/j.accpm.2015.07.004
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Titre abrégéAnaesthesia Critical Care & Pain Medicine