University of Oulu

Raatiniemi, L, Magnusson, V, Hyldmo, PK, et al. Femoral nerve blocks for the treatment of acute pre‐hospital pain: A systematic review with meta‐analysis. Acta Anaesthesiol Scand. 2020; 64: 1038– 1047.

Femoral nerve blocks for the treatment of acute pre‐hospital pain : a systematic review with meta‐analysis

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Author: Raatiniemi, Lasse1,2; Magnusson, Vidar3; Hyldmo, Per K.4,5,6;
Organizations: 1Centre for Prehospital Emergency Care, Oulu University Hospital, Oulu, Finland
2Anaesthesia Research group, MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
3Prehospital section and Department of Anaesthesia, Landspitalinn University Hospital, Reykjavik, Iceland
4Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
5Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
6Trauma Unit, Sørlandet Hospital, Kristiansand, Norway
7Research Department, Prehospital Emergency Medical Service, Central Denmark Region, Århus, Denmark
8Department of Anaesthesiology, Regional Hospital of Horsens, Horsens, Denmark
9Department of Prehospital Care and Disaster Medicine, Region of Skåne, Lund, Sweden
10Centre for Prehospital Emergency Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
11Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
12Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
13Danish Air Ambulance, Aarhus, Denmark
14Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
15Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
16Faculty of Medicine, University of Oslo, Oslo, Norway
17Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 2.4 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2020
Publish Date: 2021-04-09


Background: Pain management is one of the most important interventions in the emergency medical services. The femoral nerve block (FNB) is, among other things, indicated for pre‐ and post‐operative pain management for patients with femoral fractures but its role in the pre‐hospital setting has not been determined. The aim of this review was to assess the effect and safety of the FNB in comparison to other forms of analgesia (or no treatment) for managing acute lower extremity pain in adult patients in the pre‐hospital setting.

Methods: A systematic review (PROSPERO registration (CRD42018114399)) was conducted. The Cochrane and GRADE methods were used to assess outcomes. Two authors independently reviewed each study for eligibility, extracted the data and performed risk of bias assessments.

Results: Four studies with a total of 252 patients were included. Two RCTs (114 patients) showed that FNB may reduce pain more effectively than metamizole (mean difference 32 mm on a 100 mm VAS (95% CI 24 to 40)). One RCT (48 patients) compared the FNB with lidocaine and magnesium sulphate to FNB with lidocaine alone and was only included here for information regarding adverse effects. One case series included 90 patients. Few adverse events were reported in the included studies. The certainty of evidence was very low. We found no studies comparing FNB to inhaled analgesics, opioids or ketamine.

Conclusions: Evidence regarding the effectiveness and adverse effects of pre‐hospital FNB is limited. Studies comparing pre‐hospital FNB to inhaled analgesics, opioids or ketamine are lacking.

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Series: Acta anaesthesiologica Scandinavica
ISSN: 0001-5172
ISSN-E: 1399-6576
ISSN-L: 0001-5172
Volume: 64
Issue: 8
Pages: 1038 - 1047
DOI: 10.1111/aas.13600
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Oulu University Hospital.
Copyright information: © 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Raatiniemi, L, Magnusson, V, Hyldmo, PK, et al. Femoral nerve blocks for the treatment of acute pre‐hospital pain: A systematic review with meta‐analysis. Acta Anaesthesiol Scand. 2020; 64: 1038– 1047, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.