Peripheral nerve blocks for hip fractures in adults

Guay, Joanne; Kopp, Sandra L.

doi:10.1002/14651858.cd001159.pub3

Cited by 83 publications

(105 citation statements)

References 194 publications

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“…Recently, peripheral nerve blocks have been introduced in managing pain and minimizing the side effects and sedation related to opioid drugs[ 40 , 41 ]. In addition, continuous blocks can be included after surgical intervention for postoperative analgesia, with potentially positive effects in terms of pain, confusional state and probably in time to the first mobilization[ 42 ].…”

Section: Transdisciplinary Management Of Patients With Femur Proximal Extremity Fracturementioning

confidence: 99%

Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation

Sire

Invernizzi

Baricich

et al. 2021

WJO

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Fractures of femur proximal extremity (FFPE) are the most common fragility fractures requiring hospitalization, with a high risk of mortality, low independence in the activities of daily living and severe consequences on health-related quality of life. Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines. Early surgery (within 48 h from hospital admission) allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes. Therefore, time for surgery could be considered as a comorbidity marker. The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature, but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery. In light of these considerations, the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs. Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes, the feasibility of a comprehensive approach in clinical practice is still a challenge. In particular, the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings. Therefore, the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE, highlighting the benefits, feasibility and limitations of this approach.

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Section: Transdisciplinary Management Of Patients With Femur Proximal Extremity Fracturementioning

confidence: 99%

Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation

Sire

Invernizzi

Baricich

et al. 2021

WJO

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“…Femoral nerve blocks are beneficial both in terms of decreasing the pain experienced by older patients, as well as limiting the amount of systemic opioids administered. A Cochrane systematic review and meta-analysis on peripheral nerve blocks (PNBs) for hip fractures in adults included 49 trials (3061 participants; 1553 randomized to PNBs and 1508 to no nerve block (or sham block)) published from 1981 to 2020 [125]. The average age of participants ranged from 59 to 89 years.…”

Section: Pain Managementmentioning

confidence: 99%

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Tarazona-Santabalbina

Ojeda-Thies

Rodríguez

et al. 2021

IJERPH

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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“…There is a growing body of data, including randomized controlled trials, observational studies, consensus opinions, national audit initiatives, such as Cochrane systematic reviews (9) and PROSPECT recommendations (10), sup-porting the use of peripheral nerve blocks (PNB). PNBs effectively reduce pain and quadriceps spasm at rest and on movement, minimize time to remobilization, and reduce opioid requirements.…”

Section: Contextmentioning

confidence: 99%

“…A variety of PNBs are utilized for hip fractures: the 3in-1 block, combined lumbosacral plexus, fascia iliaca compartment, femoral nerve, lumbar plexus plus sacral plexus, posterior lumbar plexus, psoas compartment, obturator nerve, epidural, and combined blocks but the administration of some of them remain controversial (10). The most updated 2020 Cochrane review showed high-quality evidence that nerve blocks reduce pain on movement within 30 minutes by 2.5 points on a Visual Analogue scale (VAS) compared with no nerve block (9). Good quality evidence supported the early (first 48-hour) use of regional analgesia to deliver superior analgesia, spare opioid use, cut delirium, and cognitive dysfunction rates (14).…”

Section: Regional Anesthesiamentioning

confidence: 99%

Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist

Maniar¹,

Macachor

Chiew

et al. 2021

Anesth Pain Med

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: A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The study described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.

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Peripheral nerve blocks for hip fractures in adults

Cited by 83 publications

References 194 publications

Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation

Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist

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