The Lateral Femoral Cutaneous and Over the Hip (LOH) Block for the Surgical Management of Hip Fractures: A Safe and Effective Anesthetic Strategy

Deemer, Alexa R.; Furgiuele, David; Ganta, Abhishek; Leucht, Philipp; Konda, Sanjit R.; Tejwani, Nirmal C.; Egol, Kenneth A

doi:10.1097/bot.0000000000002508

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…The finding that mental health and physical function were improved 6 weeks after the treatment suggests that patient's perception of pain while they are in the hospital may have longer-term implications on patient's well-being and health-related quality of life. 2,10,[17][18][19][20][21][22][23][24][25] The findings of this study are generalizable to the typical population impacted by hip fractures. Recent trauma studies have supported the utility of surgical site injections in improving postoperative pain for the first 24 hours after administration.…”

Section: Discussionsupporting

confidence: 50%

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Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial

Ihejirika-Lomedico,

Solasz,

Lorentz

et al. 2023

Journal of Orthopaedic Trauma

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Objective: To determine whether a perioperative pain cocktail injection improves postoperative pain, ambulation distance, and long-term outcomes in patients with hip fracture. Design: Prospective, single-blinded, randomized controlled trial. Setting: Academic Medical Center. Patients/Participants: Patients with OTA/AO 31A1-3 and 31B1-3 fractures undergoing operative fixation, excluding arthroplasty. Intervention: Multimodal local injection of bupivacaine (Marcaine), morphine sulfate (Duramorph), ketorolac (Toradol) given at the fracture site at the time of hip fracture surgery (Hip Fracture Injection, HiFI). Main Outcome Measurements: Patient-reported pain, American Pain Society Patient Outcome Questionnaire (APS-POQ), narcotic usage, length of stay, postoperative ambulation, Short Musculoskeletal Function Assessment. Results: Seventy-five patients were in the treatment group and 109 in the control group. Patients in the HiFI group had a significant reduction in pain and narcotic usage compared with the control group on postoperative day (POD) 0 (P < 0.01). Based on the APS-POQ, patients in the control group had a significantly harder time falling asleep, staying asleep, and experienced increased drowsiness on POD 1 (P < 0.01). Patient ambulation distance was greater on POD 2 (P < 0.01) and POD 3 (P < 0.05) in the HiFI group. The control group experienced more major complications (P < 0.05). At 6-week postop, patients in the treatment group reported significantly less pain, better ambulatory function, less insomnia, less depression, and better satisfaction than the control group as measured by the APS-POQ. The Short Musculoskeletal Function Assessment bothersome index was also significantly lower for patients in the HiFI group, P < 0.05. Conclusions: Intraoperative HiFI not only improved early pain management and increased ambulation in patients undergoing hip fracture surgery while in the hospital, it was also associated with early improved health-related quality of life after discharge. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial

Ihejirika-Lomedico,

Solasz,

Lorentz

et al. 2023

Journal of Orthopaedic Trauma

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“…Regional anesthesia has been shown to be safe in low-velocity TP fractures, is often used, and is associated with lower pain scores and greater knee range of motion and functional outcome scores in the late postoperative period. 5 This makes it an attractive option for high-energy fractures if deemed safe.…”

Section: Discussionmentioning

confidence: 99%

Adductor and Sciatic Peripheral Nerve Catheters for Schatzker VI Tibial Plateau Fracture: A Case Report

Roth,

Medina,

Fontaine

et al. 2024

A&A Practice

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Peripheral nerve blocks are typically avoided for high-speed tibial plateau fractures due to their ability to mask the paresthesias and pain associated with the feared complication of acute compartment syndrome (ACS). We present a case in which sciatic nerve and adductor canal catheters were placed utilizing low-volume infusions allowing for neurovascular assessment. These catheters served as a valuable portion of the multi-modal pain regimen in this patient with a Schatzker VI tibial plateau fracture.

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“…They compared three groups of patients (120 total) undergoing hip fracture surgery: GA, spinal, and RA. They found numerous benefits in the regional-only group and they concluded that PENG and LFCN may decrease postoperative pain and the length of hospital stay and allow for greater ambulation in the early postoperative period for patients with hip fractures [ 21 ]. The LFCN block was again studied as a part of a primary anesthetic, this time with the FNB as the other half, in hip fracture patients with a high co-morbidity load.…”

Section: Peripheral Nerve Blocksmentioning

confidence: 99%

Peripheral Nerve Blocks for Hip Fractures

Muse,

Deiling,

Grinman

et al. 2024

JCM

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The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, adequate pain management is crucial to optimize functional recovery and early mobilization. Pain management often consists of multimodal therapy which includes non-opioids, opioids, and regional anesthesia techniques. In this review, we describe the anatomical innervation of the hip joint and summarize the commonly used peripheral nerve blocks to provide pain relief for hip fractures. We also outline literature evidence that shows each block’s efficacy in providing adequate pain relief. The recent discovery of a nerve block that may provide adequate sensory blockade of the posterior capsule of the hip is also described. Finally, we report a surgeon’s perspective on nerve blocks for hip fractures.

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The Lateral Femoral Cutaneous and Over the Hip (LOH) Block for the Surgical Management of Hip Fractures: A Safe and Effective Anesthetic Strategy

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 4 publications

References 33 publications

Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial

Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial

Adductor and Sciatic Peripheral Nerve Catheters for Schatzker VI Tibial Plateau Fracture: A Case Report

Peripheral Nerve Blocks for Hip Fractures

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