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J Am Geriatr Soc. 2016 Dec;64(12):2433-2439. doi: 10.1111/jgs.14386. Epub 2016 Oct 27.

Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial.

Author information

1
Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York City, New York.
2
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
3
James J. Peters Veterans Affairs Medical Center, Bronx, New York.
4
Maimonides Medical Center, Brooklyn, New York.
5
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
6
Mount Sinai Beth Israel, New York City, New York.
7
Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, New York.
8
University of Texas MD Anderson Cancer Center, Houston, Texas.

Abstract

OBJECTIVES:

To compared outcomes of regional nerve blocks with those of standard analgesics after hip fracture.

DESIGN:

Multisite randomized controlled trial from April 2009 to March 2013.

SETTING:

Three New York hospitals.

PARTICIPANTS:

Individuals with hip fracture (N = 161).

INTERVENTION:

Participants were randomized to receive an ultrasound-guided, single-injection, femoral nerve block administered by emergency physicians at emergency department (ED) admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours (n = 79) or conventional analgesics (n = 82).

MEASUREMENTS:

Pain (0-10 scale), distance walked on Postoperative Day (POD) 3, walking ability 6 weeks after discharge, opioid side effects.

RESULTS:

Pain scores 2 hours after ED presentation favored the intervention group over controls (3.5 vs 5.3, P = .002). Pain scores on POD 3 were significantly better for the intervention than the control group for pain at rest (2.9 vs 3.8, P = .005), with transfers out of bed (4.7 vs 5.9, P = .005), and with walking (4.1 vs 4.8, P = .002). Intervention participants walked significantly further than controls in 2 minutes on POD 3 (170.6 feet, 95% confidence interval (CI) = 109.3-232 vs 100.0 feet, 95% CI = 65.1-134.9; P = .04). At 6 weeks, intervention participants reported better walking and stair climbing ability (mean Functional Independence Measure locomotion score of 10.3 (95% CI = 9.6-11.0) vs 9.1 (95% CI = 8.2-10.0), P = .04). Intervention participants were significantly less likely to report opioid side effects (3% vs 12.4%, P = .03) and required 33% to 40% fewer parenteral morphine sulfate equivalents.

CONCLUSION:

Femoral nerve blocks performed by emergency physicians followed by continuous fascia iliaca blocks placed by anesthesiologists are feasible and result in superior outcomes.

KEYWORDS:

functional recovery; hip fracture; pain

PMID:
27787895
PMCID:
PMC5173407
DOI:
10.1111/jgs.14386
[Indexed for MEDLINE]
Free PMC Article

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