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

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 64; no. 12; pp. 2433 - 2439
• Main Authors: Morrison, R. Sean, Dickman, Eitan, Hwang, Ula, Akhtar, Saadia, Ferguson, Taja, Huang, Jennifer, Jeng, Christina L., Nelson, Bret P., Rosenblatt, Meg A., Silverstein, Jeffrey H., Strayer, Reuben J., Torrillo, Toni M., Todd, Knox H.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.12.2016; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Analgesics; Anesthesia; Clinical trials; Female; Femoral Nerve; Fractures; functional recovery; Geriatrics; hip fracture; Hip Fractures - surgery; Hip joint; Humans; Male; Middle Aged; Nerve Block - methods; New York; pain; Pain management; Pain Management - methods; Pain Measurement; Pain, Postoperative - prevention & control; Recovery of Function; Treatment Outcome; Ultrasonography, Interventional; Walking; functional recovery; pain; hip fracture
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.14386

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.