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IV Opiates versus femoral block in fractured neck of femur

Three Part Question

In [fracture neck of femur] is [IV opioid better than fermoral block] in [alleviating pain and distress]

Search Strategy

MEDLINE 1966-11/04 using the OVID interface.
[hip or exp hip fracture/ OR exp femoral neck fractures/ or femoral or exp Femur Neck/] AND [femoral or exp Femoral Nerve/ OR nerve or exp nerve block/ OR exp LIDOCAINE/ OR exp BUPIVACAINE/ OR exp Anesthetics, Local/ OR local anaesthetic$.mp. OR exp Anesthesia, Local/ OR exp Nerve Block/] LIMIT to HUMAN AND ENGLISH

Search Outcome

Altogether 65 papers found of which 8 were relevant to the study question.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Fletcher AK, Rigby AS and Heyes FLP,
50 patients age range 63-89 with fracture neck of femur 3-in-1 femoral nerve block (with 20 mL of 0.5% bupivacaine) vs systemic analgesia aloneRCTMean pain score using 0-3 scaleGreater reduction in nerve block group with mean difference [95% CI]: -0.78 [-1.02 to -0.54]Small numbers Method of radonmisation unclear
Time to best responseMean difference [95% CI]: -2.93 [-5.48 to -0.38h]
analgesic requirementsReduced in 24 hours from admission in nerve block group
Haddad FS and Williams RL,
50 patients with extracapsular fractures of the femoral neck, age range 68 - 89 Femoral nerve block (0.3 ml/kg 0.25% bupivicaine) vs systemic analgesia aloneRCTMean pain score using VASGreater reduction in nerve block group - statistically significant at 15 mins and 2 hoursSmall number of patients Only extracapsular fractures included ? Optimal analgesia given to control group
Analgesic requirementsReduced in the 24 hours from admission in nerve block group
Incidence of complicationsSignificantly reduced in nerve block group


The above studies suggest some benefit for the use of nerve block in fracture neck of femur in the pre-operative setting, in an emergency department. However the studies are small and have important weaknesses.

Clinical Bottom Line

In patients with suspected fracture neck of femur, regional nerve block may benefit in reducing parentral analgesic requirements and in achieving pain relief faster.

Level of Evidence

Level 2 - Studies considered were neither 1 or 3.


  1. Alan K.Fletcher, Alann S. Rigby, Francis L.P.Heyes three-in-one femoral Nerve block as Analgesia for fracture neck of Femur in the Emergency Department: A Randomized, Controlled Trial Annals of Emergency Medicine febuary 2003 41:2 227-233
  2. Haddad FS, Williams RL. Femoral nerve block in extracapsular femoral neck fractures. J Bone Joint Surg Br 1995;77(6):922-3.