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Am J Emerg Med. 2016 Mar;34(3):586-9. doi: 10.1016/j.ajem.2015.12.016. Epub 2015 Dec 14.

Ultrasound-guided nerve blocks for intracapsular and extracapsular hip fractures.

Author information

1
Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219.
2
Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219. Electronic address: ipushkar@maimonidesmed.org.
3
The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
4
Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029.
5
Mount Sinai Beth Israel, First Avenue at 16th St, New York, NY 10003.

Abstract

OBJECTIVES:

To compare pain relief between patients with intracapsular and extracapsular hip fractures who received an ultrasound-guided femoral nerve block (USFNB).

DESIGN:

A multicenter, prospective, randomized, clinical trial.

SETTING:

The study was conducted in the emergency departments of 3 academic hospitals located in New York City.

SUBJECTS:

Patients aged ≥60 years presenting to the emergency department with hip fracture.

METHODS:

A subgroup analysis from a larger data set was conducted of patients with intracapsular and extracapsular hip fractures who received an USFNB. We compared pain scores at baseline and then at 2 and 3 hours after the nerve block was performed, and also assessed pain relief at 2 and 3 hours.

RESULTS:

Seventy-seven patients were randomized to receive USFNB, of which 68 had follow-up data at 2 and 3 hours and were included in the data analysis. Thirty-one were diagnosed with intracapsular and 37 with extracapsular hip fractures. In both groups, reductions in pain scores were clinically and statistically significant. In the intracapsular group, mean pain scores decreased from 6.23 to 3.81 (P < .0001) at 2 hours and from 6.23 to 3.87 (P < .0001) at 3 hours. In the extracapsular group, mean pain scores decreased from 6.62 to 3.89 (P < .0001) at 2 hours and from 6.62 to 3.46 (P < .0001) at 3 hours. These differences were similar between the extracapsular and intracapsular groups at 2 hours (P = .92) and at 3 hours (P = .58), thus demonstrating similar reductions in pain in the 2 groups. The differences in pain relief between the intracapsular and extracapsular groups were also similar: 1.61 (confidence interval [CI], 1.14-2.08) vs 1.35 (CI, 0.96-1.75) at 2 hours (P = .39) and 1.68 (CI, 1.21-2.15) vs 1.38 (CI, 0.89-1.87) at 3 hours (P = .38).

CONCLUSION:

Ultrasound-guided femoral nerve block was equally effective in reducing pain for patients with both intracapsular and extracapsular hip fractures.

PMID:
26809928
PMCID:
PMC4799725
[Available on 2017-03-01]
DOI:
10.1016/j.ajem.2015.12.016
[Indexed for MEDLINE]
Free PMC Article

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