A Practical Analgesia Approach to Fragility Hip Fracture: A Single-Center, Retrospective, Cohort Study on Femoral Nerve Block

Abstract

Objective: To determine whether an effective opioid-sparing pain control modality is desirable for an aging population. Design: Retrospective observational study Setting: Academic medical center Patients: 192 patients with various types of fragility hip fractures Intervention: A single-injection femoral nerve block (FNB) Main outcome measurements: Pain score, opioid consumption Results: We observed statistically significant effects of FNB on visual analogue scale pain score and the rate of opioid consumption diminution in all commonly encountered types of fragility hip fractures. The pain score reduction by FNB in subcapital femoral neck fracture, transcervical femoral neck facture, and intertrochanteric fracture are all statistically significant (P < 0.0001). There was a statistically more significant pain score reduction in intracapsular fractures than in extracapsular fractures (P = 0.006). On average, the hip fracture patients required 0.9 and 0.1 mg morphine equivalent/hour before and after FNB block placement. This decrease in opioid consumption when calculated per unit time was statistically significant in subcapital femoral neck fracture, transcervical femoral neck facture, and intertrochanteric fracture (P < 0.0001). There were no complications related to FNB placement. Conclusions: FNB is a sustainable, safe, and useful analgesic modality for commonly encountered fragility hip fractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The impact of loco-regional anaesthesia on postoperative opioid use in elderly hip fracture patients: an observational study

“…They also found a significant decrease in opioid use and pain (as measured by VAS-score). [ 24 ] This is similar to our results.…”

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial

“…Due to various advantages, such as better comfort and safety, higher patient satisfaction, shorter hospitalization and less hospitalization cost, ultrasound-guided peripheral nerve blocks (PNB) has gained increasing popularity among anesthesiologists and patients [ 12 – 14 ]. Both prospective or retrospective studies and meta-analysis have consistently confirmed that peripheral nerve block has fewer unwanted effects on cardiopulmonary function, as well as significantly fewer related complications, as compared with other anesthesia methods [ 15 – 17 ]. Because of the particularity of the sciatic nerve, anesthesiologists can perform sciatic nerve block at many parts of the body surface, such as superior sciatic block, popliteal block and ankle joint block.…”

Intraoperatively local infiltration anesthesia in hemiarthroplasty patients reduces the needs of opioids: a randomized, double-blind, placebo-controlled trial with 96 patients in a fast-track hip fracture setting

“…Patients receiving the hip blockade less than 4 hours before surgery were excluded from the study. A singleshot nerve block is demonstrated to be effective as preoperative analgesia for hip fracture patients, reduces the needs for opioids before surgery and decreases postoperative delirium ( 24 , 25 ). The use of preoperative femoral hip blockade alone has, however, not shown a reduction in postoperative opioid consumption ( 25 ).…”