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 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 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.

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