Reducing emergency department burden through the implementation of femoral nerve block in patients with femoral fractures

Reducing emergency department burden through the implementation of femoral nerve block in patients with femoral fractures | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Reducing emergency department burden through the implementation of femoral nerve block in patients with femoral fractures View ORCID Profile Kuo-Chen Chung , View ORCID Profile Hsiu-E Chen , View ORCID Profile Chia-Hung Yeh , View ORCID Profile Subeq Yi-Maun , View ORCID Profile Shih Chieh Yang , View ORCID Profile Ching-Hui Shen , View ORCID Profile Chih-Cheng Wu doi: https://doi.org/10.1101/2025.05.30.25328613 Kuo-Chen Chung 1 Division of Trauma and Critical Care, Department of Emergency Medicine, Taichung Veterans General Hospital , Taichung, Taiwan 2 Department of Industrial Engineering and Enterprise Information, Tunghai University , Taichung, Taiwan Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Kuo-Chen Chung Hsiu-E Chen 1 Division of Trauma and Critical Care, Department of Emergency Medicine, Taichung Veterans General Hospital , Taichung, Taiwan 3 National Taichung University of Science and Technology, the Department of Nursing , Taichung, Taiwan Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hsiu-E Chen Chia-Hung Yeh 2 Department of Industrial Engineering and Enterprise Information, Tunghai University , Taichung, Taiwan Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Chia-Hung Yeh Subeq Yi-Maun 3 National Taichung University of Science and Technology, the Department of Nursing , Taichung, Taiwan Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Subeq Yi-Maun Shih Chieh Yang 4 Department of Anesthesiology, Taichung Veterans General Hospital , Taichung, Taiwan Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Shih Chieh Yang Ching-Hui Shen 4 Department of Anesthesiology, Taichung Veterans General Hospital , Taichung, Taiwan 7 Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University , Taiwan 8 School of Medicine, National Yang Ming Chiao Tung University , Taipei, Taiwan Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ching-Hui Shen Chih-Cheng Wu 4 Department of Anesthesiology, Taichung Veterans General Hospital , Taichung, Taiwan 5 Department of Financial Engineering, Providence University , Taichung, Taiwan 6 Department of Data Science and Big Data Analytics, Providence University , Taichung, Taiwan 7 Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University , Taiwan Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Chih-Cheng Wu For correspondence: chihcheng.wu{at}gmail.com Abstract Full Text Info/History Metrics Preview PDF Abstract Background Timely and effective pain management is essential in the emergency department, particularly for patients with femoral fractures. Despite their potential benefits, femoral nerve blocks remain underutilized compared to intravenous opioid administration. Methods This retrospective study evaluated patients with femoral fractures who received either femoral nerve blocks (Group 1) or standard Intravenous opioid treatment (Group 2). Pain reduction was assessed using the Numerical Rating Scale, and Intravenous opioid use was recorded. Results Group 1 experienced a significantly greater reduction in pain scores (mean decrease of 4.96 vs. 3.99; p < 0.001). While the frequency of Intravenous opioid use was slightly lower in Group 1 (1.35 vs. 1.64; p = 0.063), the trend suggests a reduction in opioid reliance. The average time to additional opioid administration post-femoral nerve blocks was 6.49 hours. Conclusions Femoral nerve blocks offer superior analgesia for femoral fractures and may reduce opioid use in the emergency departments, potentially easing the burden on emergency staff. Further studies are warranted to validate these findings. 1. Introduction 1.1 Background and Problem Statement Femoral fractures, particularly those involving the hip, are among the most painful injuries encountered in emergency departments (ER), disproportionately affecting the elderly. Effective pain management in these patients is crucial not only for comfort but also for preventing complications such as delirium, reduced mobility, and extended hospital stays. Intravenous opioid (IVO) analgesia is traditionally used for acute pain control in these settings; however, its efficacy is often compromised by ER overcrowding, which can lead to delays in administration and under-treatment. Moreover, opioids carry notable risks, including respiratory depression and cognitive impairment, especially in older adults. 1.2 Emerging Alternatives Femoral nerve blocks (FNB) have emerged as a promising alternative, offering targeted analgesia with fewer systemic side effects. Despite their advantages, FNB remain underutilized in emergency care due to variability in training, procedural complexity, and institutional limitations. 1.3 Literature Overview Recent studies support the clinical effectiveness of FNBs. For example, Scurrah et al. demonstrated enhanced early analgesia in elderly hip fracture patients [ 1 ], while Tsai et al. confirmed the feasibility of ultrasound-guided FNB in ED with better pain control than systemic opioids [ 2 ]. A meta-analysis by Hayashi et al. involving over 4,700 participants found that peripheral nerve blocks, including FNB, significantly reduced pain scores within two hours [ 3 ]. In addition to pain control, FNB may reduce opioid consumption and improve outcomes. Beaudoin et al. reported decreased need for rescue analgesia and fewer side effects with FNB [ 4 ]. Similarly, Gerlier et al. found early FNB reduced preoperative opioid requirements [ 5 ]. Unneby et al. further supported its use in elderly and cognitively impaired populations [ 6 ]. 1.4 Research Gap Despite robust evidence supporting FNB efficacy, their impact on ER workflow and opioid usage patterns is less well understood. Ritcey et al. identified barriers to FNB adoption, including lack of standardization and operational concerns[ 7 ]. Furthermore, few studies have examined whether FNBs reduce the frequency of opioid dosing and associated monitoring, potentially easing the burden on emergency staff. 1.5 Study Aim To address this gap, the current study retrospectively analyzes patients with femoral fractures who received either FNB (Group 1) or standard IVO treatment (Group 2). Outcomes assessed include changes in pain scores using the Numerical Rating Scale (NRS), frequency of opioid administration, time to additional analgesia, and implications for ER workload. The findings aim to inform clinical practice by evaluating both the therapeutic and operational benefits of FNB implementation in emergency care. 2. Materials and Methods 2.1. Study Design and Setting This retrospective comparative study was conducted at the ER of Taichung Veterans General Hospital between April 2021 and September 2023. The primary aim was to assess the analgesic effectiveness and opioid-sparing potential of FNB compared to standard IVO treatment in patients with femoral fractures. Pain severity was measured using an 11-point NRS, ranging from 0 (no pain) to 10 (worst imaginable pain). NRS scores were recorded immediately before and 60 minutes after the pain control intervention (PCI). All NRS assessments were performed by trained nursing staff who were independent of the physicians performing the interventions, minimizing potential observer bias. Eligible participants were adults (aged ≥ 18 years) who presented to the ER with radiologically confirmed femoral fractures—including fractures of the femoral head, neck, intertrochanteric region, shaft, or distal femur—and an initial NRS score of ≥ 7. Patients were excluded if they had cognitive impairment, multiple or pathological fractures, known coagulopathies, infection at the intended injection site, hypersensitivity to local anesthetics, unstable vital signs, altered mental status, pregnancy or lactation, or a body mass index > 30 kg/m2. Patients were assigned to one of two groups Group 1 (FNB group): Patients who received a femoral nerve block administered by a single experienced emergency physician using ultrasound guidance. Group 2 (IVO group): Patients who received standard pain management consisting of intravenous tramadol at 1 mg/kg. To reduce selection bias, an equal number of patients were included in each group, drawn from the same study period. Upon diagnosis, the hospital information system notified the physician for immediate intervention. If NRS scores remained ≥ 7 after PCI, a rescue IVO dose was administered. The following parameters were collected: patient demographics, fracture site, Injury Severity Score (ISS), triage level, number of IVO administrations during the ER stay, emergency room stay time (ERS, in hours), the NRS before and after PCI, and the magnitude of NRS reduction. 2.2. FNB Procedure Protocol All FNB were performed using a high-frequency linear ultrasound probe (8–18 MHz) to identify anatomical landmarks including the common femoral artery, iliopsoas muscle, sartorius muscle, and fascia iliaca. Using an in-plane approach, a 21-gauge needle was advanced under visualization to deposit local anesthetic (20 mL of 0.25% bupivacaine) adjacent to the femoral nerve, typically located just below the inguinal ligament. Aspiration was performed after every 5 mL injection to prevent intravascular administration. 2.3. Data Analysis All data were anonymized and analyzed using SPSS version 27.0 (IBM, Armonk, NY). Categorical variables were reported as frequencies and percentages, while continuous variables were expressed as means with standard deviations (SD) or medians where appropriate. Normality of distribution was assessed using the Shapiro–Wilk test. Group comparisons for categorical variables were performed using Chi-square or Fisher’s exact tests. Continuous variables were analyzed using the independent samples t-test or the Mann–Whitney U test, depending on data distribution. Pearson’s correlation coefficients were calculated to assess associations among continuous variables. Both univariate and multivariable linear regression analyses were conducted to explore predictors of opioid use and pain score reduction. A p-value of <0.05 was considered statistically significant. 2.4. Outcome Measures The primary outcome was the NRS reduction 60 minutes after the intervention, comparing FNB with IVO treatment. The secondary outcome was the number of opioid administrations required during the ER stay. Adverse events, including nerve block-related complications and any systemic reactions, were also documented. 3. Results 3.1. Baseline Characteristics A total of 248 patients were included in the analysis: 134 in the FNB group (Group 1) and 114 in the IVO group (Group 2). As shown in Table 1 , there were no statistically significant differences between the groups in terms of age (68.90 ± 23.11 vs. 66.06 ± 22.43 years, p = 0.330), sex distribution (female: 59.0% vs. 64.0%, p = 0.413), triage level (p = 0.423), or femoral fracture location (p = 0.195). These results indicate that the two groups were comparable at baseline. View this table: View inline View popup Download powerpoint Table 1. N=248, Demographics and Baseline Characteristics of Study Participants 3.2. Pain Reduction and Opioid Use Table 2 summarizes pain scores and opioid use during ERS. The NRS before PCI were similar between groups (7.96 ± 0.59 in Group 1 vs. 8.04 ± 0.69 in Group 2; p = 0.375). However, Group 1 exhibited a significantly greater reduction in pain following intervention. The mean NRS after PCI was 3.00 ± 1.21 in Group 1 compared to 4.04 ± 2.28 in Group 2 (p < 0.001), with corresponding NRS reductions of 4.96 ± 1.22 and 3.99 ± 2.26, respectively (p < 0.001). View this table: View inline View popup Download powerpoint Table 2. While the average number of IVO administrations during ERS was lower in Group 1 (1.35 ± 1.37) than in Group 2 (1.64 ± 1.01), the difference approached but did not reach statistical significance (p = 0.063). Importantly, only 49 patients (36.6%) in Group 1 required additional IVO after FNB during ERS. The average time to the first rescue opioid dose in this subgroup was 6.49 hours, with the maximum delay extending up to 18.8 hours. ERS were comparable between groups (13.56 ± 8.54 hours for Group 1 vs. 11.98 ± 7.11 hours for Group 2; p = 0.114). 3.3. Correlation Analysis Table 3 presents Pearson correlation coefficients for key variables across all patients (n = 248). Several notable relationships emerged: Age and Triage Severity: Older patients tended to present with more severe triage levels (r = 0.347, p < 0.01). Pain Control and Opioid Frequency: A negative correlation was found between NRS reduction and the frequency of IVO administration (r = –0.201, p < 0.01), suggesting that inadequate initial pain control may lead to repeated opioid dosing. Pain Scores and Pain Improvement: A strong inverse correlation between post-intervention NRS and NRS reduction (r=–0.940, p < 0.01) underscores the effectiveness of pain management in the FNB group. Opioid Use and ERS: ERS time was positively correlated with opioid administration frequency (r=0.460, p<0.01), indicating that patients who required more analgesics tended to remain in the ER longer. View this table: View inline View popup Download powerpoint Table 3. 4. Discussion Femoral fractures, particularly those involving the hip, represent one of the most significant orthopedic emergencies, especially in elderly populations. These injuries are frequently associated with high levels of acute pain, functional decline, and increased morbidity. In older adults, unmanaged or inadequately managed pain can exacerbate frailty and is linked to a cascade of adverse events, including delirium, reduced mobility,hospital-acquired complications, longer hospital stays, and elevated mortality rates [ 8 - 10 ]. Effective pain control in this context is not merely a comfort measure but a cornerstone of early intervention to improve both immediate and long-term outcomes. Traditionally, IVO have been the standard approach for managing fracture-related pain in the ED. However, opioids come with well-documented risks, such as respiratory depression, nausea, vomiting, hypotension, and especially delirium in geriatric patients [ 7 , 11 , 12 ]. Moreover, their administration in a busy ER setting often involves complex workflows, frequent monitoring, and the potential for medication delays or underdosing. These challenges underline the need for alternative analgesic strategies that are both clinically effective and operationally efficient. Some studies have shown that the use of peripheral nerve blocks and multimodal analgesia techniques may reduce the incidence of delirium and facilitate early mobilization, thus ultimately reducing morbidity and post-op 1-year mortality after hip surgery[ 11 , 13 ]. In this study, we investigated whether the early application of ultrasound-guided FNB could serve as a viable alternative to IVO administration for patients presenting to the ER with femoral fractures. Specifically, we sought to determine whether FNBs not only provide superior pain relief but also reduce the reliance on opioids and the burden on emergency department resources. 4.1. Primary Outcome: Pain Reduction Our findings indicate a clear and statistically significant advantage of FNB over standard IVO therapy in terms of acute pain reduction. The mean reduction in the NRS score was substantially greater in the FNB group (4.96) compared to the IVO group (3.99), with a p-value of < 0.001, denoting strong statistical significance. Furthermore, the post-intervention NRS score in the FNB group dropped to a mean of 3.00, which is within the range of mild pain, whereas the IVO group remained at a higher average of 4.04 (p < 0.001). This difference is not only statistically relevant but also clinically meaningful, as crossing the threshold from moderate to mild pain has implications for both patient comfort and downstream care processes. The superior efficacy of FNB likely stems from its localized mechanism of action. By delivering anesthetic directly to the femoral nerve, FNB provides targeted, rapid, and sustained analgesia that is well-suited to the pathophysiology of femoral fractures. In contrast, IVOs work systemically and may suffer from delayed onset and broader side effect profiles. Moreover, FNB’s ability to deliver consistent pain relief without sedative effects makes it particularly attractive in older patients at higher risk of opioid-induced complications. 4.2. Secondary Outcome: Opioid Use and Operational Impact In addition to superior analgesia, the use of FNB was associated with a reduction in opioid exposure during the ER stay. Only 36.6% of patients in the FNB group required rescue IVO, and the average time to additional opioid administration was significantly delayed (6.49 hours), with some patients remaining opioid-free for over 18 hours. This delay and reduced frequency of administration are particularly relevant in the current healthcare context, where concerns over opioid misuse, dependency, and side effects have become critical public health issues. Although the difference in IVO administration frequency between groups (1.35 vs. 1.64 times) did not reach conventional statistical significance (p = 0.063), the trend suggests a clinically meaningful reduction in the need for repeat dosing. In a high-throughput ER environment, even modest reductions in medication handling, reassessment, and monitoring can translate into considerable operational benefits. Notably, correlation analysis supported this interpretation, showing that greater pain relief, as measured by NRS reduction, was associated with fewer IVO administrations. Likewise, longer ER stays were positively correlated with higher opioid usage, highlighting the compounding effects of inadequate pain control on patient flow and resource allocation. From a systems-level perspective, these findings suggest that integrating FNB into routine ER protocols could lead to streamlined workflows, reduced medication burden, and more efficient patient throughput—all without compromising safety or efficacy. 4.3. Comparison with Existing Literature The findings from our study are broadly consistent with and extend those of earlier investigations into the benefits of peripheral nerve blocks for hip and femoral fractures. Hayashi et al., in a large meta-analysis of 63 randomized trials, demonstrated that peripheral nerve blocks—including femoral, fascia iliaca, and pericapsular nerve group (PENG) blocks—provided significantly better pain relief two hours after administration compared to standard care, although effects on morphine consumption were more variable[ 3 ]. Geizhals et al. reported a reduction in preoperative morphine equivalents in patients receiving FNB, albeit without reaching statistical significance (10.3 vs. 14.0 MMEs, P = 0.13)[ 14 ]. Similarly, Häusler et al. found that regional anesthesia techniques were associated with decreased postoperative opioid requirements and improved safety profiles[ 15 ]. Importantly, studies such as those by Beaudoin and Gerlier have shown that FNB not only improves pain control but also reduces the incidence of opioid-related adverse events and the need for rescue analgesia—mirroring our own findings[ 4 , 5 ]. Of particular note, Unneby et al. found that even elderly patients with cognitive impairment, such as dementia, benefited from FNBs with lower pain scores and decreased opioid consumption, emphasizing the potential of this technique in vulnerable populations [ 6 ]. 4.4. Clinical Implications FNB offers a practical and efficient alternative to systemic opioids in managing femoral fracture pain. Its implementation may reduce medication-related complications, minimize the frequency of pain reassessments, and alleviate the workload on ER staff—a significant benefit in high-pressure, resource-constrained environments. Identifying patient profiles that respond optimally to FNB could further enhance personalized pain management protocols and reduce unnecessary opioid exposure. 4.5. Study Limitations This study has several limitations. First, its retrospective design introduces the potential for selection bias and limits causal inference. Second, the procedures were conducted at a single center by a single experienced physician, which may restrict generalizability to other settings or practitioners with varying skill levels. Third, while we measured immediate pain relief and opioid usage, we did not assess longer-term outcomes such as functional recovery, complication rates, or patient satisfaction. Lastly, potential confounders—such as pre-existing pain tolerance, prior opioid exposure, or fracture severity—were not adjusted for in the current analysis. 4.6. Future Directions Further prospective, multicenter studies with randomized designs are warranted to validate these findings. Future research should also explore long-term outcomes, predictors of FNB effectiveness, and cost-effectiveness analyses to support policy-level decisions for integrating FNB into routine emergency care. Funding This research received no external funding. Institutional Review Board Statement The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Taichung Veterans General Hospital (No. CE22273B-1, 18 July 2024). Informed Consent Statement Patient consent was waived because this study is a retrospective comparative analysis and does not involve any identifiable participating patients. Data Availability Statement Data sharing is not applicable. Conflicts of Interest The authors declare no conflicts of interest. Acknowledgments The authors thank the Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital and Mr. Chen, Jun-Peng for statistical analysis. Abbreviations The following abbreviations are used in this manuscript: NRS numerical rating scale IVO intravenous opioid ER emergency department ERS emergency room stay time FNB femoral nerve blocks PCI pain control intervention ISS Injury Severity Score References 1. ↵ Scurrah A , Shiner CT , Stevens JA , Faux SG . Regional nerve blockade for early analgesic management of elderly patients with hip fracture - a narrative review . Anaesthesia . 2018 ; 73 ( 6 ): 769 – 83 . OpenUrl PubMed 2. ↵ Tsai TY , Cheong KM , Su YC , Shih MC , Chau SW , Chen MW , et al. Ultrasound-Guided Femoral Nerve Block in Geriatric Patients with Hip Fracture in the Emergency Department . J Clin Med . 2022 ; 11 ( 10 ). 3. ↵ Hayashi M , Yamamoto N , Kuroda N , Kano K , Miura T , Kamimura Y , et al. Peripheral Nerve Blocks in the Preoperative Management of Hip Fractures: A Systematic Review and Network Meta-Analysis . Ann Emerg Med . 2024 ; 83 ( 6 ): 522 – 38 . 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Share Reducing emergency department burden through the implementation of femoral nerve block in patients with femoral fractures Kuo-Chen Chung , Hsiu-E Chen , Chia-Hung Yeh , Subeq Yi-Maun , Shih Chieh Yang , Ching-Hui Shen , Chih-Cheng Wu medRxiv 2025.05.30.25328613; doi: https://doi.org/10.1101/2025.05.30.25328613 Share This Article: Copy Citation Tools Reducing emergency department burden through the implementation of femoral nerve block in patients with femoral fractures Kuo-Chen Chung , Hsiu-E Chen , Chia-Hung Yeh , Subeq Yi-Maun , Shih Chieh Yang , Ching-Hui Shen , Chih-Cheng Wu medRxiv 2025.05.30.25328613; doi: https://doi.org/10.1101/2025.05.30.25328613 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Anesthesia Subject Areas All Articles Addiction Medicine (569) Allergy and Immunology (863) Anesthesia (300) Cardiovascular Medicine (4442) Dentistry and Oral Medicine (444) Dermatology (383) Emergency Medicine (609) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1511) Epidemiology (15231) Forensic Medicine (30) Gastroenterology (1126) Genetic and Genomic Medicine (6610) Geriatric Medicine (668) Health Economics (998) Health Informatics (4542) Health Policy (1370) Health Systems and Quality Improvement (1613) Hematology (543) HIV/AIDS (1266) Infectious Diseases (except HIV/AIDS) (15923) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (147) Nephrology (668) Neurology (6607) Nursing (346) Nutrition (999) Obstetrics and Gynecology (1146) Occupational and Environmental Health (957) Oncology (3338) Ophthalmology (974) Orthopedics (369) Otolaryngology (420) Pain Medicine (436) Palliative Medicine (130) Pathology (665) Pediatrics (1693) Pharmacology and Therapeutics (692) Primary Care Research (712) Psychiatry and Clinical Psychology (5448) Public and Global Health (9239) Radiology and Imaging (2203) Rehabilitation Medicine and Physical Therapy (1370) Respiratory Medicine (1196) Rheumatology (596) Sexual and Reproductive Health (714) Sports Medicine (530) Surgery (712) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a0200faebc738df8',t:'MTc3OTgzMjkxNg=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();