Survey of all 171 acute hospitals in the United Kingdom accepting trauma admissions. On-call middle grade doctors in emergency and orthopaedic department completed a telephone survey into departmental protocol and their experience of femoral nerve blocks for lower limb fractures.
Middle grades from all 171 trusts completed the survey (100%response rate). 54 emergency departments (30.8%) had a protocol for the use of femoral nerve blocks. Middle grades in the ED reported using a nerve block routinely in 95 hospitals (54%) with 63 using a long-acting and 32 a short-acting agent. Of those that did not 70%(n = 53) felt they were unnecessary, 21%(n = 16) were not confident in the technique and 9%(n = 7) had worries over compartment syndrome. 68%would be worried about compartment syndrome in high-energy injuries. Orthopaedic departmental protocols for nerve block use were reported in 16 trusts (9%). 45 orthopaedic middle grades (26%) indicated that they would use them routinely with 17 using long-acting and 28 using short-acting agents. 59.5%(n = 75) of orthopaedic middle grades felt nerve blocks were unnecessary, whilst 22%(n = 28) had worries about compartment syndrome and 18%(n = 23) were not confident with the technique. 77%orthopaedic middle grades would be more worried about compartment syndrome in high energy injuries.
Femoral nerve block is an under-utilised, effective mode of analgesia following femoral fractures. There is a low risk of associated compartment syndrome, but clinicians should be especially vigilant in high-energy injuries. We recommend that all acute trusts receiving trauma should have a protocol for the use of femoral nerve blocks agreed by the emergency and orthopaedic departments.