Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients
- 22 May 2020
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 68 (9), 2043-2050
- https://doi.org/10.1111/jgs.16547
Abstract
BACKGROUND Geriatric hip fracture patients are susceptible to the adverse effects of opioid‐induced analgesia. Fascia iliaca blocks (FIBs) have emerged as an analgesic technique for this population. There are limited data on a preoperative FIB's effect on perioperative opioid intake. We hypothesized that preoperative FIB would reduce perioperative opioid consumption, measured in morphine milliequivalents (MMEs). DESIGN This is a prospective observational study. SETTING A level 1 trauma center in California. PARTICIPANTS From March 2017 to December 2017, patients 65 years and older presenting with a hip fracture received a preoperative FIB and were prospectively observed. This cohort was compared with a historical control. INTERVENTION All prospectively enrolled patients were given FIBs. For a single‐shot FIB, a 30‐ to 40‐mL bolus of 0.25% bupivacaine with 1:200,000 epinephrine was injected. For a continuous FIB, a bolus of 10 to 20 mL of 0.2% bupivacaine was injected, followed by a continuous infusion of 0.2% bupivacaine at 6 mL/h ending on the morning of postoperative Day 1. RESULTS A total of 725 patients were included in this study, with 92 in the prospectively collected cohort. The mean age of this cohort was 84.2 (standard deviation = 8.4) years, and 69.2% were female. Patients who received a preoperative FIB consumed less MME preoperatively, 18.0 (interquartile range = 6.0–44.5) versus 29.5 (interquartile range = 6.0–56.5) (P = .007), with no change in pain scores. No differences were found in postoperative opioid consumption between groups. There was no difference in MME or pain score in patients with dementia. Subgroup analysis based on fracture pattern (femoral neck and intertrochanteric) demonstrated a significant decrease in preoperative MME consumption in femoral neck fractures only, 12.0 (interquartile range = 5.0–24.0) versus 29.0 (interquartile range = 12.0–59.0) (P < .001). CONCLUSION FIBs reduce preoperative opioid intake and have low rates of opioid‐related adverse events in geriatric hip fracture patients. LEVEL OF EVIDENCE The level of evidence was II.This publication has 45 references indexed in Scilit:
- Peridural Anesthesia or Ultrasound-Guided Continuous 3-in-1 BlockGeriatric Orthopaedic Surgery & Rehabilitation, 2012
- Post-Operative Pain Management Practices in Patients with Dementia - The Current Situation in FinlandThe Open Nursing Journal, 2012
- Preventing Delirium in Older Adults with Recent Hip Fracture Through Multidisciplinary Geriatric ConsultationJournal of the American Geriatrics Society, 2012
- Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesicsInternational Journal of Emergency Medicine, 2010
- Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture RepairMayo Clinic Proceedings, 2010
- Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled studyJournal of Orthopaedics and Traumatology, 2009
- Differences in Prescription of Narcotic Pain Medication After Operative Treatment of Hip and Ankle Fractures in the United States and the NetherlandsThe Journal of Trauma and Acute Care Surgery, 2009
- Ultrasound Guided Fascia Iliaca BlockRegional Anesthesia & Pain Medicine, 2008
- Fascia Iliaca Compartment Blockade for Acute Pain Control in Hip Fracture PatientsAnesthesiology, 2007
- A Chart‐Based Method for Identification of Delirium: Validation Compared with Interviewer Ratings Using the Confusion Assessment MethodJournal of the American Geriatrics Society, 2005