scholarly journals Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery

2020 ◽  
Vol 10 (3) ◽  
pp. 259-266
Author(s):  
Jyoti Dangle ◽  
Promil Kukreja ◽  
Hari Kalagara
Keyword(s):  
Hip Fracture ◽  
Pain Relief ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Current Evidence ◽  
Nerve Blocks ◽  
Unique Challenge

Abstract Purpose of Review This article aims to describe the anatomical and technical aspects of various regional techniques used for fracture hip and hip surgery. We reviewed the commonly used nerve blocks, interfascial plane blocks and current evidence of their utility in hip fracture patients. Recent Findings Fascia iliaca compartment block (FICB) and femoral nerve block (FNB) are the most commonly used nerve blocks for providing pain relief for hip fracture patients. Supra-inguinal FICB has more consistent spread to all nerves and can enable better pain control. Both the FICB and FNB have shown analgesic efficacy with reduced pain scores, opioid sparing effect, and they enable better patient positioning for spinal in the operating room. These nerve blocks in the elderly patients can also have beneficial effects on delirium, reduced hospital length of stay, and decreased incidence of pneumonia. Some of the novel interfascial plane blocks like PEricapsular Nerve Group (PENG) blocks are now being explored to provide pain relief for fracture hip. Summary Hip fracture in the elderly has associated morbidity and mortality. Early surgical intervention has shown to reduce morbidity and mortality. Pain management in this elderly population poses a unique challenge and complementing with regional anesthesia for analgesia has shown numerous benefits.

scholarly journals LO58: Risk factors associated with acute in-hospital delirium for patients diagnosed with a hip fracture in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S47-S48
Author(s):  
V. Brienza ◽  
C. Thompson ◽  
A. Sandre ◽  
S.L. McLeod ◽  
S. Caine ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hip Fracture ◽  
Femoral Nerve Block ◽  
Opioid Analgesic ◽  
Femoral Nerve ◽  
Primary Objective ◽  
Hospital Length Of Stay ◽  
Multivariable Logistic Regression Analysis ◽  
Nerve Blocks

Introduction: Hip fractures affect over 35,000 Canadians each year. Delirium, or acute confusion, occurs in up to 62% of patients following a hip fracture. Delirium substantially increases hospital length of stay and doubles the risk of nursing home admissions and death. The primary objective of this study was to identify risk factors independently associated with acute in-hospital delirium within 72 hours of emergency department (ED) arrival for patients diagnosed with a hip fracture. Methods: This was a retrospective chart review of patients aged 65 years and older presenting to one of two academic EDs with a discharge diagnosis of hip fracture from January 1st 2014 to December 31st 2015. Multivariable logistic regression analysis was used to determine variables independently associated with the development of acute in-hospital delirium within 72 hours of ED arrival. Results: Of the 668 included patients, mean (SD) age was 84.1 (8.0) years and 501 (75%) were female. 521 (78.0%) patients received an opioid analgesic and/or femoral nerve block in the ED. The most common analgesics used in the ED were intravenous (IV) morphine (35.8%), IV hydromorphone (35.2%), or dual therapy with both IV hydromorphone and IV morphine (2.2%). Femoral nerve blocks were initiated for 36 (5.4%) patients and successfully completed in 35 (5.2%) patients in the ED. 181 (27.1%) patients developed delirium within 72 hours of ED arrival. History of neurodegenerative disease or dementia (OR: 5.7, 95% CI: 3.9, 8.4), age >75 (OR: 2.8, 95% CI: 1.4, 5.6) and absence of analgesia in the ED (OR: 2.1, 95% CI: 1.3, 3.2) were independently associated with acute in-hospital delirium. Conclusion: The development of in-hospital delirium is common in patients diagnosed with a hip fracture. We have identified modifiable and non-modifiable risk factors independently associated with acute in-hospital delirium, which can be identified in the ED. Clinicians should be aware of these risk factors in order to implement strategies directed at reducing the development of acute delirium. Additionally, further research is needed in order to understand the relationship between analgesia delivered in the ED and the development of delirium for patients diagnosed with a hip fracture.

scholarly journals Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy

2017 ◽  
Vol 8 (4) ◽  
pp. 268-275 ◽  
Author(s):  
Nirav H. Amin ◽  
Jacob A. West ◽  
Travis Farmer ◽  
Hrayr G. Basmajian
Keyword(s):  
Hip Fracture ◽  
Current Literature ◽  
Femoral Nerve ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Opioid Use ◽  
Greater Trochanter ◽  
Nerve Blocks ◽  
Search Terms

Introduction: Hip fracture is a common occurrence in the elderly population with high morbidity and mortality due to postoperative pain and opioid use. The goal of this article is to review the current literature on the neuroanatomy of the hip and the use of localized nerve block in controlling hip fracture pain. Methods: A thorough search of MEDLINE/PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted using the search terms “hip fracture” and “fascia iliaca block (FICB).” An additional search was conducted utilizing multiple search terms including “hip fracture,” “greater trochanter,” “femur,” “hip,” “anatomy,” “neuroanatomical,” and “anatomic.” Each search result was investigated for cadaveric studies on the innervation of the trochanteric region. Results: Twenty-five clinical studies examining the use of FICBs in hip fracture patients were identified. These studies show that FICB is safe and effective in controlling perioperative pain. Additionally, FICB has been shown to decrease opioid requirement and opioid-related side effects. Neuroanatomical studies show that the hip capsule is innervated by contributions from the femoral, obturator, sciatic, and superior gluteal nerves. Imaging studies suggest that FICB anesthetizes these branches through localized spread along the fascia iliaca plane. Cadaveric evidence suggests that the greater trochanter region is directly innervated by a single branch from the femoral nerve. Discussion: The proven efficacy of nerve blocks and their anatomic basis is encouraging to both the anesthesiologist and orthopedic surgeon. Their routine use in the hip fracture setting may improve patient outcomes, given the unacceptably high morbidity and mortality associated with opioid use. Conclusions: Localized nerve blocks, specifically FICB, have been shown to be safe and effective in managing acute hip fracture pain in geriatric patients, leading to decreased opioid use. Knowledge of the hip neuroanatomy may help guide future development of hip fracture pain blockade.

scholarly journals Femoral nerve block for pain relief in hip fracture: a dose finding study

Anaesthesia ◽  
2014 ◽  
Vol 69 (7) ◽  
pp. 683-686 ◽  
Author(s):  
M. J. Watson ◽  
E. Walker ◽  
S. Rowell ◽  
S. Halliday ◽  
M. A. Lumsden ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Relief ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Dose Finding ◽  
Finding Study ◽  
Dose Finding Study

scholarly journals Continuous Femoral Nerve Block Versus Fascia Iliaca Compartment Block as Postoperative Analgesia in Patients with Hip Fracture

PRILOZI ◽  
2014 ◽  
Vol 35 (2) ◽  
pp. 85-93 ◽  
Author(s):  
Marina Temelkovska-Stevanovska ◽  
Vesna Durnev ◽  
Marija Jovanovski-Srceva ◽  
Maja Mojsova-Mijovska ◽  
Sime Trpeski
Keyword(s):  
Hip Fracture ◽  
Side Effects ◽  
Pain Relief ◽  
Postoperative Analgesia ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Moderate Pain ◽  
Continuous Femoral Nerve Block ◽  
Leg Movement ◽  
Fascia Iliaca Compartment Block

Abstract Introduction: Systemic postoperative analgesia is inefficient in most patients with hip fracture, which is the reason for pain, especially during leg movement. Peripheral and plexus nerve blocks are an efficient option for postoperative pain relief. The aim of this study was to compare the effect and duration of continuous FNB versus a single FIC block as a postoperative analgesia in patients with hip fracture. Methods: Sixty patients with hip fracture were included and were randomly assigned to two groups of 30 patients: FNB group – patients with continuous femoral nerve block; and FIC group –patients with a single fascia iliaca compartment block. In all patients, pain intensity was measured at rest and in passive leg movement by using VDS (0–4) at several intervals: 1, 2, 12, 24, 36 and 48 hours after intervention. The amount of supplemental analgesia was measured, together with the time when the patient needed it for the first time, as well as the side effects. Results: The values of VDS were significantly lower in patients with FNB block versus patients with FIC block in rest and movement at the 24-hour intervals (46.67% vs 0% felt moderate pain), after 36 hours (43.33% vs 0% felt moderate pain) and 48 hours after intervention (46.67% vs 3.33% felt moderate to severe pain) for p < 0.05. Patients with FNB block received a significantly lower amount of supplemental analgesia, 23.3% of the FNB group vs 50% of the FIC group (p < 0.05). Registered side effects were were nausea, dizziness and sedation, and they were statistically significantly more frequent in the FIC group (p < 0.05). Conclusion: Pain relief in the postoperative period was superior in the FNB group versus the FIC group at rest and in movement in patients with hip fracture.

scholarly journals MP033: The use of femoral nerve blocks in the emergency department for hip fracture patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S77-S77
Author(s):  
A. Sandre ◽  
C. Thompson ◽  
S.L. McLeod ◽  
B. Borgundvaag
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Regional Anesthesia ◽  
Management Strategy ◽  
Femoral Nerve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Emergency Physicians ◽  
Nerve Blocks ◽  
Pain Management Strategy

Introduction: Hip fractures affect over 30,000 Canadians each year. Delirium, or acute confusion, occurs in up to 62% of patients following a hip fracture. Delirium substantially increases hospital length of stay and doubles the risk of nursing home admissions and death. Previous studies have shown that regional anesthesia is the optimal pain management strategy for hip fracture patients and has been shown to independently reduce the rate, severity and duration of delirium. However, very few emergency physicians (EPs) have the necessary training and experience to use regional anesthesia for hip fracture in the emergency department (ED). The objective of this study was to determine the number of femoral nerve blocks performed within the ED for the management of hip fracture patients. Methods: This was a retrospective chart review of patients aged 65 years and older, presenting to an academic ED (annual census 60,000) with a discharge diagnosis of hip fracture from January 1st 2014 to July 31st 2015. Results: Of the 243 hip fractures included in this study, mean (SD) age was 82.9 (8.2) years and 187 (77.0%) were female. The majority (214, 88.1%) of patients arrived to the ED by ambulance and 182 (74.9%) were categorized as CTAS 3. The most common analgesics used in the ED were intravenous (IV) hydromorphone (51.4%), IV morphine (32.1%), or dual therapy with both IV hydromorphone and IV morphine (4.9%). Femoral nerve blocks were initiated for 13 (5.3%) patients and successfully completed in 12 (4.9%) patients in the ED. Median (IQR) ED and hospital length of stay was 5.0 (3.7, 6.6) hours and 6.0 (4.1, 10.2) days, respectively. Forty-three (17.7%) patients experienced in-hospital acute delirium. Conclusion: Despite evidence to suggest regional anesthesia may be the optimal pain management strategy for hip fracture patients, the use of femoral nerve blocks in the ED remains low. Future research should attempt to elucidate barriers to use of this procedure by emergency physicians.

15. Barriers to the use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Frail Elders

2018 ◽  
Author(s):  
Madison Riddell
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Common Source ◽  
Randomized Control Trials ◽  
Nerve Blocks ◽  
Rescue Analgesia ◽  
Knowledge Translation Strategies ◽  
Randomized Control

Background: Hip fractures are a common source of pain and related morbidity among the frail elderly. One technique that has been shown to adequately manage pain in this population is the femoral nerve block. However, it is not currently employed routinely in Alberta emergency departments. Objective: The first objective was to systematically review the recent literature around the use of femoral nerve blocks. The second objective was to survey physicians about the potential barriers to routinely performing femoral nerve blocks in the emergency department. Materials and Methods: Searches of Medline, EMBASE and the Cochrane Trials database were conducted between 2010 and 2014 to identify randomized control trials examining the use of femoral nerve blocks in the ED to manage acute hip fracture pain among older adults (65 years of age and greater). The results of the systematic review were used to inform the development of the barrier survey. The survey was distributed to physician members of the Alberta Emergency and Bone & Joint Strategic Clinical Networks. Results: Seven randomized control trials were included in the review. Four studies employed a single femoral block, while three employed continuous (catheter placed) femoral blocks. All of the studies reported statistically significant reductions in pain. All but one study reported that patients treated with femoral nerve blocks consumed significantly less rescue analgesia. Finally, there were no significant adverse effects reported with the femoral block procedure. Surveys are still being collected and evaluated. Conclusions: Femoral nerve blocks appear to have benefits both in terms of decreasing pain and limiting the amount of systemic opioids administered to frail older adults experiencing a hip fracture. The results of this review and the barriers survey will help inform the development of knowledge translation strategies to increase the routine use of femoral nerve blocks.

scholarly journals Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

CJEM ◽  
2015 ◽  
Vol 18 (4) ◽  
pp. 245-252 ◽  
Author(s):  
Madison Riddell ◽  
Maria Ospina ◽  
Jayna M. Holroyd-Leduc
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Hip Fracture ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Cochrane Central Register ◽  
Nerve Blocks ◽  
Rescue Analgesia

AbstractObjectiveHip fractures are a common source of acute pain amongst the frail elderly. One potential technique to adequately manage pain in this population is the femoral nerve block. The objective of this systematic review was to provide updated evidence for the use of femoral nerve blocks as a pain management technique for older hip fracture patients in the emergency department (ED).Data SourcesSearches of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were conducted between December 2010 and May 2014. The reference list of a previous systematic review was also searched.Study SelectionWe included randomized control trials examining the use of femoral nerve blocks in the ED among older adults (65 years of age or older) with acute hip fracture.Data ExtractionAmong 93 citations reviewed, seven trials were included. Four studies employed a single femoral nerve block, while three studies employed continuous (catheter-placed) femoral blocks. All but one of the studies were found to have a high risk of bias.Data SynthesisAll studies reported reductions in pain intensity with femoral nerve blocks. All but one study reported decreased rescue analgesia requirements. There were no adverse effects found to be associated with the femoral block procedure; rather, two studies found a decreased risk of adverse events such as respiratory and cardiac complications.ConclusionsFemoral nerve blocks appear to have benefits both in terms of decreasing the pain experienced by older patients, as well as limiting the amount of systemic opioids administered to this population.

scholarly journals Combination Therapy with Continuous Three-in-One Femoral Nerve Block and Periarticular Multimodal Drug Infiltration after Total Hip Arthroplasty

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Tomonori Tetsunaga ◽  
Tomoko Tetsunaga ◽  
Kazuo Fujiwara ◽  
Hirosuke Endo ◽  
Toshifumi Ozaki
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Total Hip Arthroplasty ◽  
Combination Therapy ◽  
Hospital Stay ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Length Of Hospital Stay

Background. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. However, no studies have compared CFNB with LIA for total hip arthroplasty (THA). The aim of this study was to compare the efficacy of CFNB versus LIA after THA. Methods. We retrospectively reviewed the postoperative outcomes of 93 THA patients (20 men, 73 women; mean age 69.2 years). Patients were divided into three groups according to postoperative analgesic technique: CFNB, LIA, or combined CFNB+LIA. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). Results. The CFNB+LIA group had significantly lower VAS pain scores than the CFNB and LIA groups on postoperative day 1. There were no significant differences among the three groups in use of supplemental analgesia, side effects, mobilization, length of hospital stay, or HHS at 3 months after THA. Conclusions. Although there were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects.

Analgesia and anaesthesia

2020 ◽  
pp. 281-327
Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Femoral Nerve Block ◽  
Rapid Sequence Induction ◽  
Femoral Nerve ◽  
General Anaesthetic ◽  
Intravenous Sedation ◽  
Nerve Blocks

This chapter in the Oxford Handbook of Emergency Medicine investigates analgesia and anaesthesia in the emergency department (ED). It looks at options for relieving pain, such as the analgesics aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), morphine and other opioids, Entonox®, and ketamine, and explores analgesia for trauma and other specific situations. It discusses local anaesthesia (LA) and local anaesthetic toxicity, including use of adrenaline (epinephrine) and general principles of local anaesthesia. It explores blocks such as Bier’s block, local anaesthetic nerve blocks, intercostal nerve block, digital nerve block, median and ulnar nerve blocks, radial nerve block at the wrist, dental anaesthesia, nerve blocks of the forehead and ear, fascia iliaca compartment block, femoral nerve block, and nerve blocks at the ankle. It examines sedation, including drugs for intravenous sedation and sedation in children, and discusses general anaesthesia in the emergency department, emergency anaesthesia and rapid sequence induction, difficult intubation, and general anaesthetic drugs.

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