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Ackermann LL, Schwenk ES, Li CJ, Vaile JR, Weitz H. The effects of a multidisciplinary pathway for perioperative management of patients with hip fracture. Hosp Pract (1995) 2023; 51:233-239. [PMID: 37927222 DOI: 10.1080/21548331.2023.2274307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To determine if a multidisciplinary pathway focused on non-opioid pain management, delirium assessment, and resource utilization improved outcomes in geriatric hip fracture patients. The goal was to reduce opioid usage, consultation not congruent with guidelines, and increase use of regional anesthesia to reduce delirium and improve outcomes. METHODS An observational study was performed on hip fracture patients before and after the intervention. Hospitalists were educated on indications for preoperative cardiac consultation and specialized preoperative cardiac testing according to evidence-based guidelines with the inpatient cardiology service. Additional education on multimodal analgesia, limiting opioids, and peripheral nerve blocks was provided by the acute pain service. Pre-intervention outcomes from 1 July 20171 July 2017 to 31 May 201831 May 2018 (N = 92) were compared to post-intervention outcomes from 1 July 20181 July 2018 to 31 May 201931 May 2019 (N = 98) and included delirium, length of stay, 30-day readmission rate, time from arrival to procedure start time, time to first physical therapy session, and completion of cardiology consult time. We examined adherence, use of nerve blocks, and pre- and post-operative pain scores and opioid use. RESULTS Delirium was reduced from 50.0% (N = 46/92) to 28.6% (N = 28/98); p = 0.002. Postoperative opioid use (IV morphine milligram equivalents) decreased from an average of 57.2 mg (±67.7) to 42.6 mg (±58.2),P < .0001. There was a significant decrease in mean pre-operative (5.4 ± 4.14 to 5.05 ± 2.8, P < .0001) and post-operative pain scores (4.3 ± 5.2 to 3.2 ± 2.2, P < .0001). There was a significant reduction in time to cardiology consultation from 18 h] to 12 h ; p < .001). CONCLUSIONS A multidisciplinary collaboration between hospitalists, anesthesiologists, and cardiologists for hip fracture patients was associated with a reduction in pain and delirium and time to cardiologist evaluation. Prospective studies focusing on additional patient-centered outcomes are warranted.
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Affiliation(s)
- Lily L Ackermann
- Department of Medicine, Division of Hospital Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric S Schwenk
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Chris J Li
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Vaile
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Howard Weitz
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Neville EK, Stolic S, Wagstaff RA, Neville CC. Pain Management in the Postoperative Period for People With Dementia: An Integrative Review. ANNALS OF SURGERY OPEN 2023; 4:e301. [PMID: 37746623 PMCID: PMC10513124 DOI: 10.1097/as9.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/31/2023] [Indexed: 09/26/2023] Open
Abstract
Objective With the increased global prevalence of older people with dementia, more will present for surgery over the coming decades. Therefore, the objective of this study was to synthesize the existing research about how pain in managed for people with dementia in the postoperative period and discuss the implications for clinical practice. Methods For this integrative review, the Cumulative Index to Nursing and Allied Health literature, Medline/Pubmed, ProQuest, ERIC, and Health Source Nursing were searched to identify original empirical research published between 2000 and 2021. Tasks were divided between reviewers to ensure independent study selection, data extraction, and risk of bias assessment. Results Eleven articles were eligible. The evidence is incompletely developed therefore the review focused on pain assessment, the types and amount of pain relief, that people with dementia receive less analgesia than people without dementia and the challenges for effective pain management. Most studies were surgery for hip fracture so there is scope to look at outcomes for other types of surgery. Analgesia was administered but it was noted that even over a 20-year period, people with dementia received less than cognitively intact people. Pain management could have a stronger evidence-base with more psychometric development of pain assessment tools. Challenges are due to the impaired ability of the person with dementia to communicate pain and that clinicians have difficulty understanding pain behavior in people with dementia. Conclusion Adequate pain management for people with dementia in the postoperative period is important for a faster and better recovery.
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Affiliation(s)
- Emily K Neville
- From the Department of General Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
- University of Notre Dame Australia, School of Medicine, Wagga Wagga Rural Clinical School, Wagga Wagga, NSW, Australia
| | - Snezana Stolic
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD, Australia
| | - Ruth A Wagstaff
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Christine C Neville
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
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Sun X, Kong M. Effects of posterior lumbar plexus block on anesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric comminuted fractures. Biotechnol Genet Eng Rev 2023:1-14. [PMID: 37037007 DOI: 10.1080/02648725.2023.2200988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
To study the effect of posterior lumbar plexus nerve block on anaesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures. The research subjects selected 48 patients with postmenopausal osteoporotic subtrochanteric comminuted fractures who were hospitalized between January 2020 and January 2022, and were allocated to clusters according to the random number TBL approach. The controlling cluster (24 situations) underwent dura mater Under external anesthesia, the test cluster (24 situations) underwent posterior lumbar plexus block, and the block effect, anesthesia effect, sedation effect, hemodynamics, vital signs and reactions of adverse nature were contrasted involving the two clusters. In comparison to the control group, the test group had a longer duration of anesthesia and motor block, higher oxygenation indices but lower ITBVI, GEDVI, and ScrO2 values, lower MAP levels, and lower BIS contraction values at 5, 15, and 30 minutes following anesthesia (P < 0.05). The test group had shorter induction time and block onset time compared to the control group (P < 0.05), and a lower incidence of adverse reactions (16.67% vs. 29.17% in the control group), but the variation was not noTBL (P < 0.05). Posterior lumbar plexus nerve block in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures has a better sedative effect, shortens the induction time of anaesthesia and the onset of block, promotes sTBL haemodynamic indexes and has fewer adverse effects to ensure safety.
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Affiliation(s)
- Xiaoshan Sun
- Anaesthesiology department, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Minmin Kong
- Anaesthesiology department, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
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Effects of Lumbar Plexus Block Combined with Infiltration Anesthesia on Anesthesia Comfort Scores and Stress Responses in Elderly Patients Undergoing Hip Replacement. DISEASE MARKERS 2022; 2022:8692966. [PMID: 35990245 PMCID: PMC9385282 DOI: 10.1155/2022/8692966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Abstract
Objective. To investigate the effects of lumbar plexus block combined with infiltration anesthesia on anesthesia comfort scores and stress responses in elderly patients undergoing hip replacement. Methods. The materials of 100 elderly patients undergoing hip replacement who were treated in our hospital (January 2020-January 2021) were retrospectively analyzed, and they were equalized into the experimental group (
) and control group (
) according to the anesthesia methods. The experimental group received lumbar plexus block combined with infiltration anesthesia, and the control group received combined spinal-epidural anesthesia combined with infiltration anesthesia. The patients’ anesthesia comfort scores, stress responses, and postoperative pain indexes were compared between the two groups. Results. Compared with the control group, the experimental group achieved much lower scores of mood change, shivering response, and traction reaction (
), indicating that the anesthesia comfort in the experimental group was higher. Compared with the control group, the experimental group had much better perioperative stress response indexes (
) and eminently lower pain scores at 12 and 24 hours after surgery (
). Conclusion. Lumbar plexus block combined with infiltration anesthesia can relieve the stress responses and postoperative pain of elderly patients undergoing hip replacement and increase their anesthesia comfort. Therefore, this anesthesia method is translational in clinic.
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Li XD, Han C, Yu WL. Comparison of Femoral Nerve Block and Fascia Iliaca Block for Proximal Femoral Fracture in the Elderly Patient: A Meta-analysis. Geriatr Orthop Surg Rehabil 2022; 13:21514593221111647. [PMID: 35782718 PMCID: PMC9243384 DOI: 10.1177/21514593221111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/04/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Pain management modalities after proximal femoral fracture are variable and have been studied extensively. Regional anesthesia, specifically femoral nerve (FNB) and fascia iliaca compartment blocks (FICB), can be used to provide analgesia preoperatively. Methods Systematic searches of all related literature were conducted in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Randomized controlled trials (RCTs) of proximal femoral fractures were included. The pain scores at different time points, opioid requirement in 24 h, mean arterial pressure, time for spinal anesthesia, patient satisfaction, and incidence of side effects between the 2 groups were extracted throughout the study. Results Fifteen RCTs including 1240 patients met the inclusion criteria. The present meta-analysis indicated that compared with FNB, FICB could decrease the visual analog scale (VAS) scores at 4 h after surgery (P < .05). The incidence of side effects (nausea, vomiting, and sedation) was lower in the FNB group (P < .05). Compared to the FICB, no significant difference was found at any other observed time point. Additionally, no difference was found in opioid requirement at 24 h, mean arterial pressure, time for spinal anesthesia, or patient satisfaction (P > .05). Conclusions FICB demonstrates a reduction in VAS score at 4 while FNB decreases the risk of several adverse events. More high-quality RCTs are necessary for proper comparison of the efficacy and safety of FNB and FICB.
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Affiliation(s)
- Xiao-dan Li
- Department of Anesthesiology, Tianjin First Central Hospital, Nankai District, Tianjin, PR China
| | - Chao Han
- Department of Orthopedics, Tianjin Hospital Tianjin University, Hexi District, Tianjin, PR China
| | - Wen-li Yu
- Department of Anesthesiology, Tianjin First Central Hospital, Nankai District, Tianjin, PR China
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Is Femoral Nerve Block Superior to Fascia Iliac Block in Hip Surgery? Meta-Analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4840501. [PMID: 35647188 PMCID: PMC9135520 DOI: 10.1155/2022/4840501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/29/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
Background. Femoral nerve block (FNB) and fascia iliac compartment block (FICB) are alternative methods of pain relief during hip surgery. Nevertheless, the effectiveness and safety of FNB compared with FICB are yet to be fully determined. Methods. Electronic databases were systematically searched. Only randomized controlled trials (RCTs) on hip surgery were included. Postoperatively, the pain scores at different time points, narcotic requirements in 24 h, mean arterial pressure, spinal anesthesia (SA) time, patient satisfaction, and adverse effect rates between the two groups were extracted throughout the study. Results. Fourteen RCTs including 1179 patients were included. Compared to the FICB, FNB decreased the VAS scores postoperatively at 24 h at rest (
) and the incidence rate of some side effects (nausea, vomiting, and sedation) (
). However, compared to the FICB, no significant difference was found in the FNB regarding the VAS scores postoperatively at any of the other time points (2 min, 20 min, 2 h, 24 h at movement, 48 h at rest, and 48 h at movement). Patients in both groups had similar narcotic needs after 24 h, mean arterial pressure, SA time, and patient satisfaction (
). Conclusions. FNB has more advantages in reducing VAS scores postoperatively at 24 h at rest and the odds of some adverse effects. A better quality RCT is needed to properly compare FNB with FICB.
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Zhong H, Thor P, Illescas A, Cozowicz C, Della Valle AG, Liu J, Memtsoudis SG, Poeran J. An Overview of Commonly Used Data Sources in Observational Research in Anesthesia. Anesth Analg 2022; 134:548-558. [PMID: 35180172 DOI: 10.1213/ane.0000000000005880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Anesthesia research using existing databases has drastically expanded over the last decade. The most commonly used data sources in multi-institutional observational research are administrative databases and clinical registries. These databases are powerful tools to address research questions that are difficult to answer with smaller samples or single-institution information. Given that observational database research has established itself as valuable field in anesthesiology, we systematically reviewed publications in 3 high-impact North American anesthesia journals in the past 5 years with the goal to characterize its scope. We identified a wide range of data sources used for anesthesia-related research. Research topics ranged widely spanning questions regarding optimal anesthesia type and analgesic protocols to outcomes and cost of care both on a national and a local level. Researchers should choose their data sources based on various factors such as the population encompassed by the database, ability of the data to adequately address the research question, budget, acceptable limitations, available data analytics resources, and pipeline of follow-up studies.
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Affiliation(s)
- Haoyan Zhong
- From the Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York
| | - Pa Thor
- From the Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York
| | - Alex Illescas
- From the Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Jiabin Liu
- From the Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York.,Departments of Anesthesiology
| | - Stavros G Memtsoudis
- From the Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.,Departments of Anesthesiology.,Health Policy and Research, Weill Cornell Medical College, New York, New York
| | - Jashvant Poeran
- Departments of Population Health Science and Policy.,Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, New York
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Ohnuma T, Horres CR, Raghunathan K, Bartz RR, Krishnamoorthy V, Brookhart MA, Kent ML. Trends in multimodal analgesics among end-stage renal disease patients undergoing lower extremity amputation in the US from 2009 to 2018. Br J Anaesth 2021; 128:e43-e45. [PMID: 34852927 DOI: 10.1016/j.bja.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tetsu Ohnuma
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
| | - C Russell Horres
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA; Patient Safety Center of Inquiry, Durham VA Medical Center, Durham, NC, USA
| | - Raquel R Bartz
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | | | - M Alan Brookhart
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Michael L Kent
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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McGinn R, Talarico R, Hamiltoon GM, Ramlogan R, Wijeysundra DN, McCartney CJL, McIsaac DI. Hospital-, anaesthetist-, and patient-level variation in peripheral nerve block utilisation for hip fracture surgery: a population-based cross-sectional study. Br J Anaesth 2021; 128:198-206. [PMID: 34794768 DOI: 10.1016/j.bja.2021.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Unwarranted variation in anaesthesia practice is associated with adverse outcomes. Despite high-certainty evidence of benefit, a minority of hip fracture surgery patients receive a peripheral nerve block. Our objective was to estimate variation in peripheral nerve block use at the hospital, anaesthetist, and patient levels, while identifying predictors of peripheral nerve block use in hip fracture patients. METHODS After protocol registration (https://osf.io/48bvp/), we conducted a population-based cross-sectional study using linked administrative data in Ontario, Canada. We included adults >65 yr of age having emergency hip fracture surgery from April 1, 2012 to March 31, 2018. Logistic mixed models were used to estimate the variation in peripheral nerve block use attributable to hospital-, anaesthetist-, and patient-level factors with use of peripheral nerve block, quantified using the variance partition coefficient and median odds ratio. Predictors of peripheral nerve block use were estimated and temporally validated. RESULTS Of 50 950 patients, 9144 (18.5%) received a peripheral nerve block within 1 day of surgery. Patient-level factors accounted for 14% of variation, whereas 42% and 44% were attributable to the hospital and anaesthetist providing care, respectively. The median odds ratio for receiving a peripheral nerve block was 5.73 at the hospital level and 5.97 at the anaesthetist level. No patient factors had large associations with receipt of a peripheral nerve block (odds ratios significant at the 5% level ranged from 0.86 to 1.35). CONCLUSIONS Patient factors explain the minimal variation in peripheral nerve block use for hip fracture surgery. Interventions to increase uptake of peripheral nerve blocks for hip fracture patients will likely need to focus on structures and processes at the hospital and anaesthetist levels.
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Affiliation(s)
- Ryan McGinn
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Gavin M Hamiltoon
- ICES, Toronto, ON, Canada; Department of Anesthesiology, Queensway Carleton Hospital, Ottawa, ON, Canada
| | - Reva Ramlogan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, ON, Canada
| | - Duminda N Wijeysundra
- ICES, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Colin J L McCartney
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; ICES, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Maniar A, Macachor J, Chiew WLA, Kumar CM, Imani F, Rokhtabnak F. Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist. Anesth Pain Med 2021; 11:e116099. [PMID: 34692438 PMCID: PMC8520681 DOI: 10.5812/aapm.116099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The article described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.
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Affiliation(s)
- Amjad Maniar
- Department of Anaesthesia, Satya Sai Orthopaedic and Multispecialty Hospital, Bengaluru, India
| | - Joselo Macachor
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
| | | | - Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faranak Rokhtabnak
- Department of Anesthesiology, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Garip L, Balocco AL, Van Boxstael S. From emergency department to operating room: interventional analgesia techniques for hip fractures. Curr Opin Anaesthesiol 2021; 34:641-647. [PMID: 34325461 DOI: 10.1097/aco.0000000000001046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an update on pain management options with regional anesthesia for patients with hip fractures at the emergency department (ED). RECENT FINDINGS Patients who sustain a hip fracture are typically admitted and diagnosed in the ED before being transferred to the operating room for surgery. Studies have clearly demonstrated the ability of the fascia iliaca compartment blocks (FICBs) and femoral nerve blocks (FNBs) to reduce pain and the risk of an acute confusional state. Their administration at an early stage of the patient's trajectory in the ED is beneficial. Recent anatomical studies contributed new knowledge of nociception in the hip joint, which allowed the development of more specific infiltration analgesia techniques without muscle weakness (e.g., pericapsular hip blocks). Further research on the timing of nerve blocks and an evaluation of new motor sparing techniques is indicated. SUMMARY FICB and FNB are established and recommended techniques in pain management for hip fracture patients. Their use early on in the ED may improve patient comfort and outcome. Pericapsular nerve hip blocks could provide a relevant alternative in future pain management in this group of patients.
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Affiliation(s)
- Levin Garip
- Critical Care Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Angela L Balocco
- Critical Care Department, Ziekenhuis Oost-Limburg, Genk, Belgium
- UHasselt, Faculty of Medicine and Life Sciences & Limburg Clinical Research Center, Diepenbeek, Belgium
| | - Sam Van Boxstael
- Critical Care Department, Ziekenhuis Oost-Limburg, Genk, Belgium
- UHasselt, Faculty of Medicine and Life Sciences & Limburg Clinical Research Center, Diepenbeek, Belgium
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12
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Binder EF. Nerve Block Use after Hip Fracture: Missed Opportunities to Improve Pain Management? J Am Geriatr Soc 2020; 68:689-690. [PMID: 32124978 DOI: 10.1111/jgs.16364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Ellen F Binder
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Missouri
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