Femoral Nerve Anesthesia in Hostile Environments (Mountains)

Philippe Mahiou

doi:doi:10.11648/j.ijbse.20221002.13

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Femoral Nerve Anesthesia in Hostile Environments (Mountains)

Philippe Mahiou

Published in International Journal of Biomedical Science and Engineering (Volume 10, Issue 2)

Received: 20 May 2022 Accepted: 6 June 2022 Published: 16 June 2022

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Abstract

Traumatic injuries associated with adventure sports activities occur in hostile environment. The Femoral nerve anesthesia (FNA) outside of the hospital settings has been demonstrated but not in hostile environment. So, the objective of this study was to determine the feasibility of FNA for these very painful traumatized patients on the accident site and during their extraction-evacuation by helicoper. This prospective observational study was enrolled a convenience sample of 11 patients (4 women, 7 men) with closed fractures femurs. FNA was performed on all participants and 3 situations were defined (Impossible, Difficult if more than 1 attempt, Easy to perform). Pain evaluated using visual analog scale (VAS) (0-10) measured at the following time point: Rescue team arrival (T0), Ten minutes after FNA (T10), at Reduction of fracture (T Reduction) and during helicopter Evacuation (T Evacuation). The median age of the participants was aged 40 +/- 18 years. The accidents which occurred were 7 Skiing, 2 moutaineering, 1 snowshoeing, 1 parapliding. 11 FNA performed with 5 fascia iliaca blocks, 6 femoral nerve blocks. 82% blocks were technically easy and 18% difficult. Pain evaluation showed an average VAS of 7,5 (7-8) at T0, 1,1 (0-2) at T10, 0,45 (0-1) at T Reduction, 0,36 (0-1) at T Evacuation. All the pathologies were treated with reduction and immobilization. Helicopter evacuations were conducted without incident in a calm atmosphere and with excellent patient cooperation. In final, FNA performed in difficult environment is feasible, effective, and reproducible in extreme conditions. There is no limitation due to hostile terrain. FNA techniques used must simple and fast but performed by trained physicians who are technical experts in order achieve a successful outcome in difficult terrain.

Published in	International Journal of Biomedical Science and Engineering (Volume 10, Issue 2)
DOI	10.11648/j.ijbse.20221002.13
Page(s)	50-53
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Traumatology, Hostile Environments, Prehospital Analgesia, Regional Anesthesia, Femoral Nerve Anesthesia, Helicopter Evacuation

References

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[2]	Recommandations formalisées d’experts - Anesthésie locorégionale périnerveuse (ALR-PN). (Expert panel guidelines on perineural anesthesia) - Société Française d’Anesthésie et de Réanimation (SFAR) 2016.
[3]	Kettner SC, Willschke H, Marhofer P. Does regional anaesthesia really improve outcome? Br J Anaesthesia 2011; 107 (Suppl 1): i90-i95.
[4]	Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med 2010; 28: 76-81.
[5]	Pennington N, Gadd RJ, Green N, Loughenbury PR. A national survey of acute hospitals in England on their current practice in the use of femoral nerve blocks when splinting femoral fractures. Injury 2012; 43: 843-845.
[6]	Elkhodair S, Mortazavi J, Chester A, Pereira M. Single fascia iliaca compartment block for pain relief in patients with fractured neck of femur in the emergency department: a pilot study. Eur J Emerg Med 2011; 18: 340-343.
[7]	Dolan J, Williams A, Murney E, et al. Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Reg Anesth Pain Med 2008; 33: 526-53.
[8]	Drasner K. Local anesthetic systemic toxicity. Reg Anesth Pain Med 2010; 35: 162-166.
[9]	Lopez S, Gros T, Bernard N, Plasse C, Capdevilla X. Fascia iliaca compartment block for femoral bone fractures in préhospital care. Reg Anesth Pain Med 2003; 28: 203-207.
[10]	Fortin JL, Astraud C, Fuilla C, Lallement D, Dubourdieu S, Ruttimann M, ZimmermannMP, Kowalski JJ. Epidémiologie et pratique du bloc iliofascial en situation extra-hospitalière à la Brigade des Sapeurs-Pompiers de Paris. Urgence Pratique 2005; 73: 29-31.
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[13]	Ageron FX, Metton P, Casimiri ML, Binault G, Savary D, Belle L, Perfis JP. Enquête sur les pratiques d’anesthésie locorégionale par les urgentistes au sein d’un réseau interhospitalier. JEUR 2007; 20: S25-S28, 54.
[14]	Foss N. B., Kristensen B. B., Bundgaard M. and al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology 2007, vol. 106, n°4: 773-778.
[15]	Beaudoin F. L., Nagdev A., Merchant R. C., and Becker B. M. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. American Journal of Emergency Medicine 2010, vol. 28, n°1, 76-81.
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Philippe Mahiou. (2022). Femoral Nerve Anesthesia in Hostile Environments (Mountains). International Journal of Biomedical Science and Engineering, 10(2), 50-53. https://doi.org/10.11648/j.ijbse.20221002.13

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ACS Style

Philippe Mahiou. Femoral Nerve Anesthesia in Hostile Environments (Mountains). Int. J. Biomed. Sci. Eng. 2022, 10(2), 50-53. doi: 10.11648/j.ijbse.20221002.13

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Philippe Mahiou. Femoral Nerve Anesthesia in Hostile Environments (Mountains). Int J Biomed Sci Eng. 2022;10(2):50-53. doi: 10.11648/j.ijbse.20221002.13

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@article{10.11648/j.ijbse.20221002.13,
  author = {Philippe Mahiou},
  title = {Femoral Nerve Anesthesia in Hostile Environments (Mountains)},
  journal = {International Journal of Biomedical Science and Engineering},
  volume = {10},
  number = {2},
  pages = {50-53},
  doi = {10.11648/j.ijbse.20221002.13},
  url = {https://doi.org/10.11648/j.ijbse.20221002.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijbse.20221002.13},
  abstract = {Traumatic injuries associated with adventure sports activities occur in hostile environment. The Femoral nerve anesthesia (FNA) outside of the hospital settings has been demonstrated but not in hostile environment. So, the objective of this study was to determine the feasibility of FNA for these very painful traumatized patients on the accident site and during their extraction-evacuation by helicoper. This prospective observational study was enrolled a convenience sample of 11 patients (4 women, 7 men) with closed fractures femurs. FNA was performed on all participants and 3 situations were defined (Impossible, Difficult if more than 1 attempt, Easy to perform). Pain evaluated using visual analog scale (VAS) (0-10) measured at the following time point: Rescue team arrival (T0), Ten minutes after FNA (T10), at Reduction of fracture (T Reduction) and during helicopter Evacuation (T Evacuation). The median age of the participants was aged 40 +/- 18 years. The accidents which occurred were 7 Skiing, 2 moutaineering, 1 snowshoeing, 1 parapliding. 11 FNA performed with 5 fascia iliaca blocks, 6 femoral nerve blocks. 82% blocks were technically easy and 18% difficult. Pain evaluation showed an average VAS of 7,5 (7-8) at T0, 1,1 (0-2) at T10, 0,45 (0-1) at T Reduction, 0,36 (0-1) at T Evacuation. All the pathologies were treated with reduction and immobilization. Helicopter evacuations were conducted without incident in a calm atmosphere and with excellent patient cooperation. In final, FNA performed in difficult environment is feasible, effective, and reproducible in extreme conditions. There is no limitation due to hostile terrain. FNA techniques used must simple and fast but performed by trained physicians who are technical experts in order achieve a successful outcome in difficult terrain.},
 year = {2022}
}

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TY - JOUR
T1 - Femoral Nerve Anesthesia in Hostile Environments (Mountains)
AU - Philippe Mahiou
Y1 - 2022/06/16
PY - 2022
N1 - https://doi.org/10.11648/j.ijbse.20221002.13
DO - 10.11648/j.ijbse.20221002.13
T2 - International Journal of Biomedical Science and Engineering
JF - International Journal of Biomedical Science and Engineering
JO - International Journal of Biomedical Science and Engineering
SP - 50
EP - 53
PB - Science Publishing Group
SN - 2376-7235
UR - https://doi.org/10.11648/j.ijbse.20221002.13
AB - Traumatic injuries associated with adventure sports activities occur in hostile environment. The Femoral nerve anesthesia (FNA) outside of the hospital settings has been demonstrated but not in hostile environment. So, the objective of this study was to determine the feasibility of FNA for these very painful traumatized patients on the accident site and during their extraction-evacuation by helicoper. This prospective observational study was enrolled a convenience sample of 11 patients (4 women, 7 men) with closed fractures femurs. FNA was performed on all participants and 3 situations were defined (Impossible, Difficult if more than 1 attempt, Easy to perform). Pain evaluated using visual analog scale (VAS) (0-10) measured at the following time point: Rescue team arrival (T0), Ten minutes after FNA (T10), at Reduction of fracture (T Reduction) and during helicopter Evacuation (T Evacuation). The median age of the participants was aged 40 +/- 18 years. The accidents which occurred were 7 Skiing, 2 moutaineering, 1 snowshoeing, 1 parapliding. 11 FNA performed with 5 fascia iliaca blocks, 6 femoral nerve blocks. 82% blocks were technically easy and 18% difficult. Pain evaluation showed an average VAS of 7,5 (7-8) at T0, 1,1 (0-2) at T10, 0,45 (0-1) at T Reduction, 0,36 (0-1) at T Evacuation. All the pathologies were treated with reduction and immobilization. Helicopter evacuations were conducted without incident in a calm atmosphere and with excellent patient cooperation. In final, FNA performed in difficult environment is feasible, effective, and reproducible in extreme conditions. There is no limitation due to hostile terrain. FNA techniques used must simple and fast but performed by trained physicians who are technical experts in order achieve a successful outcome in difficult terrain.
VL - 10
IS - 2
ER -

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Author Information

Philippe Mahiou

Department of Anesthesiology and Intensive Care, Cedres Clinic, Echirolles, France

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APA Style

Philippe Mahiou. (2022). Femoral Nerve Anesthesia in Hostile Environments (Mountains). International Journal of Biomedical Science and Engineering, 10(2), 50-53. https://doi.org/10.11648/j.ijbse.20221002.13

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ACS Style

Philippe Mahiou. Femoral Nerve Anesthesia in Hostile Environments (Mountains). Int. J. Biomed. Sci. Eng. 2022, 10(2), 50-53. doi: 10.11648/j.ijbse.20221002.13

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AMA Style

Philippe Mahiou. Femoral Nerve Anesthesia in Hostile Environments (Mountains). Int J Biomed Sci Eng. 2022;10(2):50-53. doi: 10.11648/j.ijbse.20221002.13

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@article{10.11648/j.ijbse.20221002.13,
  author = {Philippe Mahiou},
  title = {Femoral Nerve Anesthesia in Hostile Environments (Mountains)},
  journal = {International Journal of Biomedical Science and Engineering},
  volume = {10},
  number = {2},
  pages = {50-53},
  doi = {10.11648/j.ijbse.20221002.13},
  url = {https://doi.org/10.11648/j.ijbse.20221002.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijbse.20221002.13},
  abstract = {Traumatic injuries associated with adventure sports activities occur in hostile environment. The Femoral nerve anesthesia (FNA) outside of the hospital settings has been demonstrated but not in hostile environment. So, the objective of this study was to determine the feasibility of FNA for these very painful traumatized patients on the accident site and during their extraction-evacuation by helicoper. This prospective observational study was enrolled a convenience sample of 11 patients (4 women, 7 men) with closed fractures femurs. FNA was performed on all participants and 3 situations were defined (Impossible, Difficult if more than 1 attempt, Easy to perform). Pain evaluated using visual analog scale (VAS) (0-10) measured at the following time point: Rescue team arrival (T0), Ten minutes after FNA (T10), at Reduction of fracture (T Reduction) and during helicopter Evacuation (T Evacuation). The median age of the participants was aged 40 +/- 18 years. The accidents which occurred were 7 Skiing, 2 moutaineering, 1 snowshoeing, 1 parapliding. 11 FNA performed with 5 fascia iliaca blocks, 6 femoral nerve blocks. 82% blocks were technically easy and 18% difficult. Pain evaluation showed an average VAS of 7,5 (7-8) at T0, 1,1 (0-2) at T10, 0,45 (0-1) at T Reduction, 0,36 (0-1) at T Evacuation. All the pathologies were treated with reduction and immobilization. Helicopter evacuations were conducted without incident in a calm atmosphere and with excellent patient cooperation. In final, FNA performed in difficult environment is feasible, effective, and reproducible in extreme conditions. There is no limitation due to hostile terrain. FNA techniques used must simple and fast but performed by trained physicians who are technical experts in order achieve a successful outcome in difficult terrain.},
 year = {2022}
}

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