护理人员实施的用于股骨骨折的髂筋膜间隙阻滞：一项对照试验。
Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial.
作者信息
McRae Paul J, Bendall Jason C, Madigan Veronica, Middleton Paul M
机构信息
NSW Ambulance, Rozelle, New South Wales, Australia; School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia.
NSW Ambulance, Rozelle, New South Wales, Australia; School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia; Department of Anaesthesia, Gosford Hospital, Gosford, New South Wales, Australia.
出版信息
J Emerg Med. 2015 May;48(5):581-9. doi: 10.1016/j.jemermed.2014.12.016. Epub 2015 Feb 7.
BACKGROUND
Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. These injuries are painful, and the need for extrication and transport adds complexity to the management of this condition. Whereas traditional analgesia involves parenteral opioids, regional nerve blockade for femoral fractures have been demonstrated to be effective when performed by physicians. Regional peripheral nerve blockade performed by paramedics may be suitable in the prehospital setting.
STUDY OBJECTIVES
To examine the efficacy and feasibility of paramedic-performed fascia iliaca compartment block (FICB) for patients with suspected hip or femur fractures in the prehospital setting compared to intravenous morphine alone.
METHODS
Prior to treatment allocation, all patients received a loading dose of morphine intravenously, then received either 1) FICB using lidocaine with epinephrine; or 2) standard care (further intravenous morphine only) in this nonblinded, randomized control trial. Participants rated their pain using a standard 11-point verbal numerical rating scale prior to and 15 min after receiving the allocated treatment. Secondary outcomes included effectiveness at other time points and incidence of adverse effects.
RESULTS
We analyzed 11 and 13 patients in the FICB and standard care groups, respectively. Patients treated with FICB had a greater reduction in their median pain score than patients in the standard care group (50% vs. 22%, p = 0.025) after 15 min. In the FICB group, median pain scores decreased by 5 (interquartile range 4-6), compared to 2 (interquartile range 0-4) in the standard care group. The FICB procedure did not significantly impact on scene times. No immediately obvious adverse events were noted in the 11 participants who received FICB from paramedics.
CONCLUSION
The study suggests that FICB can be performed by trained paramedics for patients with suspected femoral fractures.
背景
股骨（大腿）骨折是护理人员常见的重要临床问题。这些损伤会引起疼痛，而解救和转运的需求增加了这种情况管理的复杂性。传统的镇痛方法包括胃肠外使用阿片类药物，而医生实施的股骨骨折区域神经阻滞已被证明是有效的。护理人员实施的区域外周神经阻滞可能适用于院前环境。
研究目的
在院前环境中，与单独静脉注射吗啡相比，研究护理人员实施的髂筋膜间隙阻滞（FICB）对疑似髋部或股骨骨折患者的疗效和可行性。
方法
在进行治疗分配之前，所有患者均静脉注射负荷剂量的吗啡，然后在这项非盲、随机对照试验中接受以下两种治疗之一：1）使用利多卡因加肾上腺素进行FICB；或2）标准护理（仅进一步静脉注射吗啡）。参与者在接受分配的治疗前和治疗后15分钟使用标准的11点言语数字评定量表对疼痛进行评分。次要结局包括其他时间点的有效性和不良反应发生率。
结果
我们分别分析了FICB组和标准护理组的11例和13例患者。15分钟后，接受FICB治疗的患者中位疼痛评分的降低幅度大于标准护理组患者（50%对22%，p = 0.025）。在FICB组中，中位疼痛评分降低了5分（四分位间距4 - 6），而标准护理组为2分（四分位间距0 - 4）。FICB操作对现场停留时间没有显著影响。在接受护理人员FICB治疗的11名参与者中，未观察到立即出现的明显不良事件。
结论
该研究表明，经过培训的护理人员可以对疑似股骨骨折的患者实施FICB。
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