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Kolodychuk N, Dubé M, DiNicola N. Preoperative Fascia Iliaca Blocks Associated With Decreased Opioid Consumption in Femoral Shaft and Distal Femur Fractures. J Orthop Trauma 2024; 38:373-377. [PMID: 38506513 DOI: 10.1097/bot.0000000000002806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To examine the impact of fascia iliaca (FI) blocks performed in the emergency department on femoral shaft and distal femur fracture patients on opioid consumption, length of stay (LOS), and readmission rate. METHODS DESIGN Prospective cohort study. SETTING Community-based Level 1 trauma center. PATIENT SELECTION CRITERIA Patients with isolated low-energy femoral shaft or distal femur fractures (OTA/AO 32 and 33) presenting from January 1, 2020, to May 31, 2022, were included. OUTCOME MEASURES AND COMPARISONS Opioid consumption, LOS, discharge disposition, and 30-day readmission rate were compared between patients undergoing FI compartment block and not receiving the block. RESULTS One hundred thirty-six patients were included. Twenty-four received FI block. Both cohorts were primarily female gender (66.7% and 66.9%, respectively, for the FI block and the no FI block cohort). Most of the FI block cohort had femoral shaft fractures (62.5%), whereas the no FI block cohort had mostly distal femur fractures (56.2%). The mean body mass index, fracture type, and surgical procedure were similar between patients undergoing FI block and not receiving FI block. The FI block group had significantly lower opioid consumption preoperatively [36.1 vs. 55.3 morphine milliequivalents (MMEs), P = 0.030], postoperatively (71.7 vs. 130.6 MMEs, P = 0.041), and over total hospital stay (107.9 vs. 185.9 MMEs) including the mean opioid consumption per day of hospital stay (25.9 vs. 48.4 MMEs, P = 0.003). There was no significant difference in LOS (4.9 vs. 5.0 days, P = 0.900), discharge disposition destination ( P = 0.200), or 30-day readmissions (12.5% vs. 4.5%, P = 0.148) between groups. CONCLUSIONS Undergoing FI block in the emergency department was associated with decreased opioid consumption in patients with femoral shaft or distal femur fractures. There was no associated difference in LOS, discharge disposition, or 30-day readmissions. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nicholas Kolodychuk
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Michael Dubé
- Northeast Ohio Medical University, Rootstown, OH; and
- Department of Orthopedic Surgery, Cleveland Clinic Akron General Medical Center, Akron, OH
| | - Nicholas DiNicola
- Department of Orthopedic Surgery, Cleveland Clinic Akron General Medical Center, Akron, OH
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Chen Y, Lin J, Chen X, Gong C, Xue F, Huang Y, Xie Y, Jiang J, Zheng X, Liao Y. The addition of peripheral nerve blocks to routine spinal or general anesthesia was associated with decreased risks of major adverse events after total hip or knee arthroplasty: A retrospective, propensity score-matched cohort study. Heliyon 2024; 10:e32441. [PMID: 39183870 PMCID: PMC11341287 DOI: 10.1016/j.heliyon.2024.e32441] [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: 02/28/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 08/27/2024] Open
Abstract
Background Although total joint arthroplasty is the most effective procedures for end-stage arthritis, the incidence of postoperative death and complications remains high. The association of additional peripheral nerve blocks (PNBs) to routine spinal or general anesthesia with major adverse events (including mortality and complication rates) in elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) has been subject to inconclusive findings. Methods This retrospective observational single institution study included all patients ≧ 18 years undergoing their first elective THA or TKA from January 1, 2012 to December 31, 2021. A 1:2 propensity score matching (PSM) was performed to account for the baseline differences between two groups that were accepted to PNB or not. Kaplan-Meier curves were employed to estimate the effects of PNB on mortality. The associations of PNB and the complications were assessed by logistic regression models. Results We identified 1328 patients, among whom 197 had PNB and 1131 had not. The 90-day all-cause mortality was significantly reduced in patients with PNBs (0 % vs 2.79 %, P = 0.041) after THA or TKA, when compared to the non-PNB group. PNB was also associated with a lower risk of pulmonary complications (odds ratio [OR], 0.430; 95%confidence interval [CI],0.216-0.857) and deep vein thrombosis (OR, 0.103; 95%CI, 0.011-0.954). Interpretation The results of this observational, propensity score-matched cohort study suggested a strong association between the addition of PNBs to routine spinal or general anesthesia and decreased risks of major adverse events.
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Affiliation(s)
- Yingjie Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jingfang Lin
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaoying Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Cansheng Gong
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Fushan Xue
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yongxin Huang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yawen Xie
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jundan Jiang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of “Belt and Road”, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, China
| | - Yanling Liao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, China
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Cocea AC, Stoica CI. Interactions and Trends of Interleukins, PAI-1, CRP, and TNF-α in Inflammatory Responses during the Perioperative Period of Joint Arthroplasty: Implications for Pain Management-A Narrative Review. J Pers Med 2024; 14:537. [PMID: 38793119 PMCID: PMC11122505 DOI: 10.3390/jpm14050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Inflammation during the perioperative period of joint arthroplasty is a critical aspect of patient outcomes, influencing both the pathophysiology of pain and the healing process. This narrative review comprehensively evaluates the roles of specific cytokines and inflammatory biomarkers in this context and their implications for pain management. Inflammatory responses are initiated and propagated by cytokines, which are pivotal in the development of both acute and chronic postoperative pain. Pro-inflammatory cytokines play essential roles in up-regulating the inflammatory response, which, if not adequately controlled, leads to sustained pain and impaired tissue healing. Anti-inflammatory cytokines work to dampen inflammatory responses and promote resolution. Our discussion extends to the genetic and molecular influences on cytokine production, which influence pain perception and recovery rates post-surgery. Furthermore, the role of PAI-1 in modulating inflammation through its impact on the fibrinolytic system highlights its potential as a therapeutic target. The perioperative modulation of these cytokines through various analgesic and anesthetic techniques, including the fascia iliac compartment block, demonstrates a significant reduction in pain and inflammatory markers, thus underscoring the importance of targeted therapeutic strategies. Our analysis suggests that a nuanced understanding of the interplay between pro-inflammatory and anti-inflammatory cytokines is required. Future research should focus on individualized pain management strategies.
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Affiliation(s)
- Arabela-Codruta Cocea
- Faculty of Medicine, Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Ioan Stoica
- Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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Wang S, Xu Y, Kang Y, Qin Z, Peng C, Lin H. Effect of different analgesic treatments on the pulmonary function in elderly hip fracture patients: A prospective study. Medicine (Baltimore) 2023; 102:e34505. [PMID: 37603509 PMCID: PMC10443746 DOI: 10.1097/md.0000000000034505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND To investigate the effect of different analgesic methods on lungs in elderly patients with hip fractures. METHODS A prospective study was conducted on 78 elderly hip fracture patients undergoing spinal anesthesia for surgery, where 3 analgesic methods were used: postoperative Patient-controlled intravenous analgesia pump (PCIA) (group I), pre and postoperative PCIA (group II), and preoperative fascia iliaca compartment block (FICB) + postoperative PCIA (group III). The following indicators were monitored at admission (T1), on the day of surgery before anesthesia (T2), and 7 days after surgery (T3): heart rate (HR), respiratory rate (RR), forced expiratory volume during the first second, arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), C-reactive protein (CRP), and interleukin 6 (IL-6). Pulmonary complications such as pulmonary atelectasis and respiratory insufficiency were analyzed. RESULTS The HR, RR, forced expiratory volume during the first second, PaO2, PaCO2, IL-6, and CRP levels at T1 after fracture did not significantly differ among the 3 groups (P > .05). After different analgesic treatments post-admission, all indicators at T2 were significantly higher in group I than in groups II and III (P < .05), while there was no significant difference between groups II and III (P > .05). At T3, there were no significant differences in RR, HR, PaO2, PaCO2, and CRP levels among the groups (P > .05), but IL-6 levels at T3 were significantly higher in group I than in groups II and III (P < .05). CONCLUSION The use of effective pain relief during surgery can help protect the lung function of elderly patients with hip fractures. When using PCIA with FICB before surgery, respiratory performance may be better protected compared to using unsustained analgesia. This could be due to a decrease in the levels of inflammatory markers such as CRP and interleukin-6.
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Affiliation(s)
- Shunhong Wang
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Yueming Xu
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Yongjian Kang
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Zhigang Qin
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Chunyu Peng
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Hong Lin
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
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Huang F, Qian H, Gao F, Chen J, Zhang G, Liu Y, Chen Y, Lin X, Chen F, Song W, Yang D, Chen W, Jiang C, Liu C, Zheng T, Gong C, Ye P, Zheng X. Effect of Ultrasound-Guided Fascia Iliac Compartment Block with Nalbuphine and Ropivacaine on Preoperative Pain in Older Patients with Hip Fractures: A Multicenter, Triple-Blinded, Randomized, Controlled Trial. Pain Ther 2022; 11:923-935. [PMID: 35674985 PMCID: PMC9314510 DOI: 10.1007/s40122-022-00397-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/17/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Pain management for older patients with hip fractures is challenging. This study aimed to investigate the effect of ultrasound-guided fascia iliac compartment block (UGFICB) using different doses of nalbuphine in combination with ropivacaine on preoperative analgesia in older patients with hip fractures. METHODS In this multicenter randomized controlled trial, 280 elderly patients with hip fracture were randomly allocated into four UGFICB groups (n = 70 in each group): a ropivacaine group (30 mL 0.1% ropivacaine + 0.9% normal saline) and three ropivacaine plus nalbuphine groups (5, 10, and 20 mg nalbuphine, respectively). The primary outcomes were the duration of analgesia at rest and on passive movement. Secondary outcomes included sensory block area, side effects, and vital signs. The doses of rescue analgesia with parecoxib sodium were also analyzed. RESULTS The addition of nalbuphine dose-dependently increased the duration of analgesia at rest and on passive movement (P < 0.05) and expanded the area of sensory block (P < 0.05). Compared with the ropivacaine group, the pain scores at rest and on movement at 6 and 8 h after the block were lower in three ropivacaine plus nalbuphine groups (P < 0.05), without between-group differences at 2, 4, and 12 h. The four groups had comparable side effects (nausea and vomiting) and vital signs (P > 0.05). CONCLUSIONS UGFICB with 5, 10, and 20 mg nalbuphine added to ropivacaine prolonged the analgesia duration, increased sensory block area, reduced pain, and decreased the doses of rescue parecoxib sodium for older patients after hip fracture, without obvious side effects. Among these three doses, nalbuphine 20 mg in combination with ropivacaine provided the longest duration of analgesia and the largest sensory block area. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2000029934).
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Affiliation(s)
- Fengyi Huang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China
| | - Haitao Qian
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China
| | - Fei Gao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China
| | - Jianghu Chen
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China
| | - Guopan Zhang
- Department of Anesthesiology, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, China
| | - Yonglin Liu
- Department of Anesthesiology, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, China
| | - Yijia Chen
- Department of Anesthesiology, Longyan People's Hospital, Longyan, Fujian, China
| | - Xinqiang Lin
- Department of Anesthesiology, The Affiliated Hospital of Putian College, Putian, China
| | - Fei Chen
- Department of Anesthesiology, Min Dong Hosptial of Ningde, Ningde, China
| | - Wei Song
- Department of Anesthesiology, Zhengxing Hospital of Zhangzhou, Zhangzhou, China
| | - Daihe Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Wenbin Chen
- Department of Anesthesiology, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
| | - Changcheng Jiang
- Department of Anesthesiology, The First Hospital of Quanzhou, Quanzhou, China
| | - Chuyun Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Ting Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China
| | - Cansheng Gong
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China
| | - Peng Ye
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China.
- Fujian Provincial Institute of Emergency Medicine, Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Joint Laboratory of Fujian's Belt and Road, Fuzhou, China.
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Kingston M, Jones J, Black S, Evans B, Ford S, Foster T, Goodacre S, Jones ML, Jones S, Keen L, Longo M, Lyons RA, Pallister I, Rees N, Siriwardena AN, Watkins A, Williams J, Wilson H, Snooks H. Clinical and cost-effectiveness of paramedic administered fascia iliaca compartment block for emergency hip fracture (RAPID 2)-protocol for an individually randomised parallel-group trial. Trials 2022; 23:677. [PMID: 35978361 PMCID: PMC9385096 DOI: 10.1186/s13063-022-06522-3] [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: 05/31/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Approximately 75,000 people fracture a hip each year in the UK. This painful injury can be devastating—with a high associated mortality rate—and survivors likely to be more dependent and less mobile. Pain relief at the scene of injury is known to be inadequate. Intravenous morphine is usually given by paramedics, but opioids are less effective for dynamic pain and can cause serious side effects, including nausea, constipation, delirium and respiratory depression. These may delay surgery, require further treatment and worsen patient outcomes. We completed a feasibility study of paramedic-provided fascia iliaca compartment block (FICB), testing the intervention, trial methods and data collection. The study (RAPID) demonstrated that a full trial was feasible. In this subsequent study, we aim to test safety, clinical and cost-effectiveness of paramedic-provided FICB as pain relief to patients with suspected hip fracture in the prehospital environment. Methods We will conduct a pragmatic multi-centre individually randomised parallel-group trial, with a 1:1 allocation between usual care (control) and FICB (intervention). Hospital clinicians in five sites (paired ambulance services and receiving hospitals) in England and Wales will train 220 paramedics to administer FICB. The primary outcome is change in pain score from pre-randomisation to arrival at the emergency department. One thousand four hundred patients are required to find a clinically important difference between trial arms in the primary outcome (standardised statistical effect ~ 0.2; 90% power, 5% significance). We will use NHS Digital (England) and the SAIL (Secure Anonymised Information Linkage) databank (Wales) to follow up patient outcomes using routine anonymised linked data in an efficient study design, and questionnaires to capture patient-reported outcomes at 1 and 4 months. Secondary outcomes include mortality, length of hospital stay, job cycle time, prehospital medications including morphine, presence of hip fracture, satisfaction, mobility, and NHS costs. We will assess safety by monitoring serious adverse events (SAEs). Discussion The trial will help to determine whether paramedic administered FICB is a safe, clinically and cost-effective treatment for suspected hip fracture in the pre-hospital setting. Impact will be shown if and when clinical guidelines either recommend or reject the use of FICB in routine practice in this context. Trial registration ISRCTN15831813. Registered on 22 September 2021.
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Affiliation(s)
| | | | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | | | - Simon Ford
- Swansea Bay University Health Board, Port Talbot, UK
| | - Theresa Foster
- East of England Ambulance Service NHS Trust, Melbourn, UK
| | | | | | | | - Leigh Keen
- Welsh Ambulance Services NHS Trust, St Asaph, UK
| | | | | | - Ian Pallister
- Swansea Bay University Health Board, Port Talbot, UK
| | - Nigel Rees
- Welsh Ambulance Services NHS Trust, St Asaph, UK
| | | | | | - Julia Williams
- South East Coast Ambulance Services NHS Foundation Trust, Crawley, UK
| | - Helen Wilson
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Effect of Ultrasound-Guided Fascia Iliac Compartment Block on Serum NLRP3 and Inflammatory Factors in Patients with Femoral Intertrochanteric Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1944659. [PMID: 35620203 PMCID: PMC9129941 DOI: 10.1155/2022/1944659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022]
Abstract
Objective To investigate the effects of ultrasound-guided fascia iliac compartment block (FICB) on patients' postoperative pain and inflammatory factors as well as nucleotide-binding domain and leucine-rich repeat (NLR) family, pyrin domain-containing 3 (NLRP3) in femoral intertrochanteric fracture. Methods This single-blind randomized controlled study included 231 patients with femoral intertrochanteric fracture treated in our hospital from January 2017 to December 2020. All patients were randomized into two groups, the FICB group (n = 116) and the general anesthesia group (control group, n = 115). The serum NLRP3 levels and inflammatory factors were evaluated. The heart rate (HR), mean arterial pressure (MAP), and SpO2 values were recorded. Pain condition was measured by the visual analogue scale (VAS) score. Harris score was performed for positive hip function. Results The values of HR and MAP were significantly lower after anesthesia induction in FICB groups compared with the control group. However, no significant difference was found for SpO2. Compared with the control group, the VAS scores within 72 h after surgery were all markedly lower in the FICB group than in the control group and showed no significant difference at 1 week after surgery. The levels of NLRP3 and interleukin 6 (IL-6) were significantly lower in FICB patients at 1 h, 6 h, 24 h, 48 h, and 72 h after surgery compared with the control group. Tumor necrosis factor-α (TNF-α) showed a significant lower level in the FICB group at 1 h and 6 h after surgery, and significant lower levels of C-reactive protein (CRP) were found at 1 h and 24 h after surgery compared with the control group. Positive correlation was found between NLRP3 and IL-6, as well as CRP and VAS scores after 1 h of the surgery. No significant difference was found for both Harris score and postoperative complications between the two groups. Conclusion Fascia iliac compartment block could reduce the postoperative pain, which might be associated with the decrease of the serum levels of NLRP3, CRP, IL-6, and TNF-α in femoral intertrochanteric fracture patients.
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Fascia Iliaca Blocks Performed in the Emergency Department Decrease Opioid Consumption and Length of Stay in Patients with Hip Fracture. J Orthop Trauma 2022; 36:142-146. [PMID: 34294666 DOI: 10.1097/bot.0000000000002220] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine the impact of fascia iliaca (FI) blocks performed in the emergency department on patients with hip fracture on opioid consumption, length of stay, and readmission rate. DESIGN Prospective cohort study. SETTING Community-based Level 1 trauma center. PATIENTS/PARTICIPANTS Ninety-eight patients with isolated femoral neck, intertrochanteric, and subtrochanteric femur fractures (OTA/AO 31-A and 31-B) presenting from January 1, 2020, to June 30, 2020. INTERVENTION Ultrasound-guided FI compartment block using 40 mL of 0.25% bupivacaine. MAIN OUTCOME MEASUREMENTS Opioid consumption, length of stay, discharge disposition, and 30-day readmission rate. RESULTS Thirty-three patients had contraindication to FI block. Thirty-nine of 65 patients (60%) without contraindications to undergoing FIB received FI block. Mean age, body mass index, fracture type, and surgical procedure were similar between patients undergoing FIB and not receiving FIB. The FIB group had significantly lower opioid consumption preoperatively [17.4 vs. 32.0 morphine milliequivalents (MMEs)], postoperatively (37.1 vs. 85.5 MMEs), over total hospital stay (54.5 vs. 117.5 MMEs), and mean opioid consumption per day of hospital stay (13.3 vs. 24.0 MMEs). Patients in the FIB group had shorter length of stay compared with the control group (4.3 vs. 5.2 days). There was no significant difference in discharge disposition destination between groups. No patients reported complications of FI block. CONCLUSIONS Undergoing FI block in the emergency department was associated with decreased opioid consumption, decreased length of stay, and decreased hospital readmission within 30 days of hip fracture. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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The Effect of Fascia Iliaca Compartment Blockade on Mortality in Patients With Hip Fractures: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Am Acad Orthop Surg 2022; 30:e384-e394. [PMID: 35772091 DOI: 10.5435/jaaos-d-21-00561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The purpose of this meta-analysis was to determine whether perioperative fascia iliaca compartment blockade (FICB) decreases mortality in patients with hip fracture. METHODS MEDLINE (PubMed and Ovid platforms), Web of Science, EMBASE, and Cochrane Database of Systemic Reviews were screened for "fascia iliaca compartment block, hip fracture" articles in English, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from January 1, 2005, to March 1, 2020. All relevant randomized controlled trials and cohort and case-control studies were included for analysis. Relevant article titles were identified, and their corresponding abstracts were independently reviewed by two authors for inclusion. The full-text articles were then obtained for all relevant identified abstracts and assessed for inclusion in the meta-analysis. Conflicts in quality assessment between the two independent reviewers were resolved by a consensus vote of all authors. RESULTS Study quality was assessed objectively using the Jadad and Newcastle-Ottawa Scale. This meta-analysis was done in accordance with the PRISMA (http://links.lww.com/JAAOS/A731) and QUORUM guidelines. Quantitative synthesis analysis was done using Cochrane Reviews Review Manager (version 5.3). All analyses were completed using random-effects models and comparing the individual effect sizes within each study. DISCUSSION Management of hip fracture pain with FICB does not markedly decrease short-term mortality. Our findings support the continued use of FICB for the management of hip fractures in geriatric patients and suggest the need for future prospective randomized controlled trials to further determine FICB's effect on short-term and long-term mortality and functional status. LEVEL OF EVIDENCE Therapeutic level I.
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Makkar JK, Singh NP, Bhatia N, Samra T, Singh PM. Fascia iliaca block for hip fractures in the emergency department: meta-analysis with trial sequential analysis. Am J Emerg Med 2021; 50:654-660. [PMID: 34879482 DOI: 10.1016/j.ajem.2021.09.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fascia iliaca block (FICB) has been used to reduce pain and its impact on geriatric patients with hip fractures. OBJECTIVE We conducted this meta-analysis to investigate the analgesic efficacy of this block in comparison to standard of care (SOC) when performed by non-anesthesiologist in the emergency department. METHODS Search on PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane database for randomized and quasi-randomized trials were performed. The primary outcome was to compare pain relief at rest at 2-4 h. The pain relief at various time intervals, reduction in opioid use, the incidence of nausea/ vomiting, delirium and length of hospital stay were the secondary outcomes studied. Trial Sequential Analysis (TSA) was performed for the primary outcome. RESULTS Eleven trials comprising 895 patients were included in the meta-analysis. Patients receiving FICB had significant better pain relief at rest at 2-4 h with mean difference of 1.59 (95% CI, 0.59-2.59, p = 0.002) with I2 = 96%. However, the certainty of the evidence was low and TSA showed that the sample size could not reach the requisite information size. A significant difference in pain relief at rest and on movement started within 30 min and lasted till 4 h of the block. Use of FICB was associated with a significant reduction in post-procedure parenteral opioid consumption, nausea and vomiting and length of hospital stay. CONCLUSIONS FICB is associated with significant pain relief both at rest and on movement lasting up to 4 h as well as a reduction in opioid requirement and associated nausea and vomiting in geriatric patients with hip fracture. However, the quality of evidence is low and additional trials are necessary.
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Affiliation(s)
- Jeetinder K Makkar
- Professor, Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Narinder P Singh
- Department of Anaesthesia, MMIMSR, MM (DU), Mullana, Ambala, India.
| | - Nidhi Bhatia
- Additional Professor, Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Tanvir Samra
- Associate Professor, Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Rasappan K, Chua ITH, Tey JBL, Ho SWL. The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients. Arch Orthop Trauma Surg 2021; 141:29-37. [PMID: 32361955 DOI: 10.1007/s00402-020-03450-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hip fractures are common orthopaedic injuries in the elderly. Opioids can provide peri-operative pain relief in hip fracture patients, but may have side effects. Peripheral nerve blocks such as the fascia iliaca compartment block (FICB) have become an established part of the multimodal analgesic regime administered peri-operatively to hip fracture patients. We compare the efficacy of the continuous infusion FICB (CFICB) on peri-operative pain relief, opioid usage, its associated complications and the short as well as long term rehabilitation status in geriatric hip fractures patients. MATERIALS AND METHODS In this retrospective matched case control study, 40 geriatric patients with hip fractures who had received the CFICB from Nov 2014 to April 2016 were matched in a 1:3 ratio with similar patients whom had not received the CFICB from our institution's hip fracture database of 913 patients. RESULTS A total of 157 patients in both the CFICB group (N = 40) and the control group (N = 117) were studied. The post-operative pain scores and the total opioid consumption during the first 3 days in the CFICB group were significantly less than the control group (p < 0.0001, respectively). The systemic complications in the CFICB group were comparable with the control group. The CFICB group had slower rehabilitation at up to 2 weeks but there was no significant difference at 1 year post surgery in terms of function and mobility between the two groups. In both groups, better pre-fracture function was associated with faster short term rehab outcomes in post-operative patients. CONCLUSION The CFICB provides safe and effective post-operative pain relief in geriatric hip fracture patients. Post-operative opioid usage is decreased in older hip fracture patients treated with CFICB. Rehabilitation milestones are slower in the short term, but have no significant difference at 1-year post surgery.
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Affiliation(s)
- Kumaran Rasappan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Ivan Tjun Huat Chua
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - John Boon Lim Tey
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hopsital, Singapore, Singapore
| | - Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Abstract
BACKGROUND This review was published originally in 1999 and was updated in 2001, 2002, 2009, 2017, and 2020. Updating was deemed necessary due to the high incidence of hip fractures, the large number of official societies providing recommendations on this condition, the possibility that perioperative peripheral nerve blocks (PNBs) may improve patient outcomes, and the major role that PNBs may play in reducing preoperative and postoperative opioid use for analgesia. OBJECTIVES To compare PNBs used as preoperative analgesia, as postoperative analgesia, or as a supplement to general anaesthesia versus no nerve block (or sham block) for adults with hip fracture. Outcomes were pain on movement at 30 minutes after block placement, acute confusional state, myocardial infarction, chest infection, death, time to first mobilization, and costs of an analgesic regimen for single-injection blocks. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. SEARCH METHODS For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), in the Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2019); Embase (Ovid SP, 1974 to November 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to November 2019), as well as trial registers and reference lists of relevant articles. SELECTION CRITERIA We included randomized controlled trials (RCTs) assessing use of PNBs compared with no nerve block (or sham block) as part of the care provided for adults 16 years of age and older with hip fracture. DATA COLLECTION AND ANALYSIS: Two review authors independently screened new trials for inclusion, assessed trial quality using the Cochrane Risk of Bias-2 tool, and extracted data. When appropriate, we pooled results of outcome measures. We rated the certainty of evidence using the GRADE approach. MAIN RESULTS We included 49 trials (3061 participants; 1553 randomized to PNBs and 1508 to no nerve block (or sham block)). For this update, we added 18 new trials. Trials were published from 1981 to 2020. Trialists followed participants for periods ranging from 5 minutes to 12 months. The average age of participants ranged from 59 to 89 years. People with dementia were often excluded from the included trials. Additional analgesia was available for all participants. Results of 11 trials with 503 participants show that PNBs reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.05, 95% confidence interval (CI) -1.25 to -0.86; equivalent to -2.5 on a scale from 0 to 10; high-certainty evidence). Effect size was proportionate to the concentration of local anaesthetic used (P = 0.0003). Based on 13 trials with 1072 participants, PNBs reduce the risk of acute confusional state (risk ratio (RR) 0.67, 95% CI 0.50 to 0.90; number needed to treat for an additional beneficial outcome (NNTB) 12, 95% CI 7 to 47; high-certainty evidence). For myocardial infarction, there were no events in one trial with 31 participants (RR not estimable; low-certainty evidence). From three trials with 131 participants, PNBs probably reduce the risk for chest infection (RR 0.41, 95% CI 0.19 to 0.89; NNTB 7, 95% CI 5 to 72; moderate-certainty evidence). Based on 11 trials with 617 participants, the effects of PNBs on mortality within six months are uncertain due to very serious imprecision (RR 0.87, 95% CI 0.47 to 1.60; low-certainty evidence). From three trials with 208 participants, PNBs likely reduce time to first mobilization (mean difference (MD) -10.80 hours, 95% CI -12.83 to -8.77 hours; moderate-certainty evidence). One trial with 75 participants indicated there may be a small reduction in the cost of analgesic drugs with a single-injection PNB (MD -4.40 euros, 95% CI -4.84 to -3.96 euros; low-certainty evidence). We identified 29 ongoing trials, of which 15 were first posted or at least were last updated after 1 January 2018. AUTHORS' CONCLUSIONS: PNBs reduce pain on movement within 30 minutes after block placement, risk of acute confusional state, and probably also reduce the risk of chest infection and time to first mobilization. There may be a small reduction in the cost of analgesic drugs for single-injection PNB. We did not find a difference for myocardial infarction and mortality, but the numbers of participants included for these two outcomes were insufficient. Although randomized clinical trials may not be the best way to establish risks associated with an intervention, our review confirms low risks of permanent injury associated with PNBs, as found by others. Some trials are ongoing, but it is unclear whether any further RCTs should be registered, given the benefits found. Good-quality non-randomized trials with appropriate sample size may help to clarify the potential effects of PNBs on myocardial infarction and mortality.
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Affiliation(s)
- Joanne Guay
- Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Canada
- Teaching and Research Unit, Health Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Canada
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Laval University, Quebec City, Canada
| | - Sandra Kopp
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Liang Y, Lv L, He L, Deng W, Chen C, Li J. A Randomized Controlled Trial of FNB versus FICB for Patients with Femoral Neck Fractures Before Spinal Anesthesia. Clin Interv Aging 2020; 15:1113-1119. [PMID: 32764898 PMCID: PMC7360407 DOI: 10.2147/cia.s251025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Patients with femoral neck fractures often suffer severe pain. This randomized controlled clinical study compared the effect of femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in this population. Patients and Methods Forty-six patients were randomly assigned to one of the two groups: FNB group (femoral nerve block, n=23) or FICB group (fascia iliaca compartment block, n=23). Before positioning for spinal anesthesia, patients received FNB with 15 mL of 0.5% ropivacaine or FICB with 40 mL of 0.5% ropivacaine. Pain was evaluated using a visual analogue scale (VAS) at rest and during hip flexion after admission to the operation room; at 3, 5, 8, and 10 min after analgesia intervention; and during positioning for spinal anesthesia. Positioning was attempted after 10 min of analgesia intervention in each group. Time required to perform spinal anesthesia, quality of positioning, and patient satisfaction were documented. Results The VAS scores in the FNB group were significantly lower than those in FICB group at 3 and 5 min after analgesia intervention (P=0.000). However, there were no significant differences in VAS between groups at 8 or 10 min or during positioning. Conclusion FNB and FICB produce similar analgesic effects in patients with femoral neck fractures, but FNB has a more rapid onset of pain relief.
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Affiliation(s)
- Yi Liang
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Lv Lv
- Emergency Department, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Liang He
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Wei Deng
- Department of Anesthesiology, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), Jiaxing, People's Republic of China
| | - Cai Chen
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Jingjuan Li
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
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Garlich JM, Pujari A, Debbi EM, Yalamanchili DR, Moak ZB, Stephenson SK, Stephan SR, Polakof LS, Johnson CR, Noorzad AS, Little MTM, Moon CN, Black JT, Anand KK, Lin CA. Time to Block: Early Regional Anesthesia Improves Pain Control in Geriatric Hip Fractures. J Bone Joint Surg Am 2020; 102:866-872. [PMID: 32195685 DOI: 10.2106/jbjs.19.01148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fascia iliaca nerve blocks (FIBs) anesthetize the thigh and provide opioid-sparing analgesia for geriatric patients with hip fracture awaiting a surgical procedure. FIBs are recommended for preoperative pain management; yet, block administration is often delayed for hours after admission, and delays in pain management lead to worse outcomes. Our objective was to determine whether opioid consumption and pain following a hip fracture are affected by the time to block (TTB). We also examined length of stay and opioid-related adverse events. METHODS This prospective cohort study included patients who were ≥60 years of age, presented with a hip fracture, and received a preoperative FIB from March 2017 to December 2017. Individualized care timelines, including the date and time of admission, block placement, and surgical procedure, were created to evaluate the effect that TTB and time to surgery (TTS) had on outcomes. Patterns among TTB, TTS, and morphine milligram equivalents (MME) were investigated using the Spearman rho correlation. For descriptive purposes, we divided patients into 2 groups based on the median TTB. Multivariable regression for preoperative MME and length of stay was performed to assess the effect of TTB. RESULTS There were 107 patients, with a mean age of 83.3 years, who received a preoperative FIB. The median TTB was 8.5 hours. Seventy-two percent of preoperative MME consumption occurred before block placement (pre-block MME). A longer TTB was most strongly correlated with pre-block MME (rho = 0.54; p < 0.001), and TTS was not correlated. Patients with a faster TTB consumed fewer opioids preoperatively (12.0 compared with 33.1 MME; p = 0.015), had lower visual analog scale scores for pain on postoperative day 1 (2.8 compared with 3.5 points; p = 0.046), and were discharged earlier (4.0 compared with 5.5 days; p = 0.039). There were no differences in preoperative pain scores, postoperative opioid consumption, delirium, or opioid-related adverse events. Multivariate regression showed that every hour of delay in TTB was associated with a 2.8% increase in preoperative MME and a 1.0% increase in the length of stay. CONCLUSIONS Faster TTB in geriatric patients with hip fracture may reduce opioid use, pain, and length of stay. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John M Garlich
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Amit Pujari
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Eytan M Debbi
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | | | - Zachary B Moak
- Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, California
| | - Samuel K Stephenson
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Stephen R Stephan
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Landon S Polakof
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Christopher R Johnson
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Ali S Noorzad
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Milton T M Little
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Charles N Moon
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Jeanne T Black
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Kapil K Anand
- Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, California
| | - Carol A Lin
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
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15
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Gupta M, Kamath SS. Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: an observational study. Korean J Pain 2020; 33:138-143. [PMID: 32235014 PMCID: PMC7136299 DOI: 10.3344/kjp.2020.33.2.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/05/2022] Open
Abstract
Background Severe pain associated with proximal femur fractures makes the positioning for regional anesthesia a challenge. Systemic administration of analgesics can have adverse effects. Individually, both the fascia iliaca block (FIB) and femoral nerve blocks (FNB) have been studied. However, there is little evidence comparing the two. The aim of this study was to compare the overall efficacy of the two blocks in patients with proximal femur fracture before positioning for spinal anesthesia. Methods ASA (American Society of Anesthesiologists) class I, II, and III patients scheduled for elective and emergency surgery with the diagnosis of proximal femur fracture between October 2018 and June 2019 were included in the study. The patients were assigned to two groups by convenience nonprobability sampling of 35 each. Results Our study showed a reduction in visual analogue scale scores at 3, 4, and 5 minutes after administration of the FIB being 5.1 ± 1.1, 4.1 ± 1.3, and 2.8 ± 0.8, and those after the FNB as 4.4 ± 1.1, 3.3 ± 1.1, and 2.1 ± 1.4 with P < 0.05, which was statistically significant. The mean first rescue analgesia time for the FIB was 7.1 ± 2.1 hours, while for the FNB it was 5.2 ± 0.7 hours. The P value was less than 0.001, which was significant. Conclusions Both ultrasound guided FNB and FIB techniques provide sufficient analgesia for patient's positioning before spinal anesthesia. However, the duration of postoperative analgesia provided by FIB was greater than that of the FNB.
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Affiliation(s)
- Meeta Gupta
- Department of Anesthesiology, Kasturba Medical College of Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Shaila Surendra Kamath
- Department of Anesthesiology, Kasturba Medical College of Mangalore, Manipal Academy of Higher Education, Manipal, India
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Hao J, Dong B, Zhang J, Luo Z. Pre-emptive analgesia with continuous fascia iliaca compartment block reduces postoperative delirium in elderly patients with hip fracture. A randomized controlled trial. Saudi Med J 2020; 40:901-906. [PMID: 31522217 PMCID: PMC6790481 DOI: 10.15537/smj.2019.9.24483] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate whether pre-emptive analgesia is an effective technique to reduce postoperative delirium (PD) in geriatric patients with hip fracture. METHODS This is a double-blind randomized clinical trial. Ninety elderly patients scheduled for hipfracture surgery at HongHui Hospital, Xi'an Jiaotong University, Xi'an, China between March 2018 and January 2019 were divided into 2 groups. On arrival at the emergency department, the experimental group (n=44) received ultrasound-guided continuous fascia iliaca compartment block (FICB) for preoperative analgesia, while the control group (n=46) received fake (or generic) continuous FICB. All patients received spinal anaesthesia and postoperative patient controlled epidural analgesia (PCEA). We compared the change in preoperative and postoperative pain scores, the incidence of PD, and the consumption of opioids between the 2 groups. Results: Five patients did not meet the participation requirements; therefore, 85 patients were included in the study. Patients in the experimental group experienced less preoperative pain (p less than 0.05). Between the 2 groups, no significant differences were found for postoperative pain scores. The incidence of PD was lower in the experimental group (13.9% versus 35.7%, p=0.018). In addition, before the surgery, a drop in consumption of fentanyl was noted in the experimental group (0.08±0.21 versus 0.28±0.13, p=0.037).Conlusion: Pre-emptive analgesia with continuous FICB is an effective technique to reduce PD in geriatric patients with hip fracture.
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Affiliation(s)
- Jianhong Hao
- Department of Anesthesiology, HongHui Hospital, Xi'an JiaoTong University, Xi'an, China. E-mail.
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17
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Liu X, Hu X, Li R, Zhang Y. Combination of post-fascia iliaca compartment block and dexmedetomidine in pain and inflammation control after total hip arthroplasty for elder patients: a randomized control study. J Orthop Surg Res 2020; 15:42. [PMID: 32041613 PMCID: PMC7011216 DOI: 10.1186/s13018-020-1562-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
Objective This study aims to investigate the efficiency of fascia iliaca compartment block (FICB) combined with dexmedetomidine (DEX) in postoperative and inflammation management for elder patients after total hip arthroplasty. Methods The present randomized controlled study included a total of 119 elder patients who received total hip arthroplasty in our hospital from March 2016 to December 2018. These patients were divided into three groups: control group, patients received routine general anesthesia; FICB group, patients received additional FICB after surgery; and combined group, patients received both pre-treatment of DEX and post-treatment of fascia iliaca compartment block. The serum levels of interleukin (IL)-1β, IL-6, and C-reactive protein (CRP) were measured by ELISA. The visual analog scale (VAS) score was measured at 12, 24, 48, and 72 h after surgery, and the patient-controlled intravenous analgesia (PCIA) pressing time within 48 h after surgery was also recorded. The Pittsburgh sleep quality index (PSQI) was used to measure the sleep quality before and at 1 month after surgery. Results The VAS scores were significantly lower in patients in the combined group, when compared with the other two groups, at 12, 24, 48, and 72 h after surgery. In addition, the VAS scores at all time points were significantly lower in the FICB group than the control group. The PCIA pressing times were also remarkably lower in the combined group. At 4, 24, 48, and 72 h after surgery, the serum levels of these inflammatory factors were the lowest in the combined group, and the PSQI scores were significantly lower in the combined group, when compared with the other two groups, while the control group had the highest PSQI scores among the three groups. There was no severe side effects and significant difference observed. Conclusion FICB combined with DEX reduced the postoperative pain, improved the sleep condition, and decreased the serum levels of inflammatory factors after total hip arthroplasty.
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Affiliation(s)
- Xiaofen Liu
- Department of Anesthesiology and Perioperative Medicine, The Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230000, China
| | - Xianwen Hu
- Department of Anesthesiology and Perioperative Medicine, The Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230000, China
| | - Rui Li
- Department of Anesthesiology and Perioperative Medicine, The Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230000, China
| | - Ye Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230000, China.
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Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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Fascia Iliaca Block Decreases Hip Fracture Postoperative Opioid Consumption: A Prospective Randomized Controlled Trial. J Orthop Trauma 2020; 34:49-54. [PMID: 31469752 DOI: 10.1097/bot.0000000000001634] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the efficacy of a preoperative fascia iliaca compartment block in decreasing postoperative pain and improving functional recovery after hip fracture surgery. DESIGN Randomized prospective Level 1 therapeutic. SETTING Academic Level 1 trauma center. PATIENTS Geriatric patients with fractures of the proximal femur (neck, intertrochanteric, or subtrochanteric regions) were prospectively randomized into an experimental (A) or control (B) groups. Forty-seven patients met inclusion criteria, 23 randomized to the experimental group and 24 to the control group. INTERVENTION Patients randomized to the experimental group received an ultrasound-guided fascia iliaca compartment block administered by a board-certified anesthesiologist immediately before the initiation of anesthesia. MAIN OUTCOME MEASUREMENTS Primary outcome measure was postoperative pain medication consumption until postoperative day 3. Secondary outcomes included functional recovery and a study-specific patient-reported satisfaction survey assessed on postoperative day 3. RESULTS There was no significant difference in consumption of acetaminophen for mild pain, tramadol for moderate pain, or functional recovery between the 2 groups. There was a statistically significant decrease in morphine consumption (0.4 mg vs. 19.4 mg, P = 0.05) and increase in patient-reported satisfaction (31%, P = 0.01). CONCLUSIONS Preoperative fascia iliaca compartment block significantly decreases postoperative opioid consumption while improving patient satisfaction. We recommend the integration of this safe and efficacious modality into institutional geriatric hip fracture protocols as an adjunctive pain control strategy. LEVEL OF EVIDENCE Therapeutic Level II See Instructions for Authors for a complete description of levels of evidence.
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20
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Chen H, Li J, Chang Z, Liang X, Tang P. Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach. J Orthop Translat 2019; 19:126-132. [PMID: 31844620 PMCID: PMC6896481 DOI: 10.1016/j.jot.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/24/2019] [Accepted: 04/04/2019] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of the study is to explore the clinical effect of a dynamic condylar screw (DCS) system, medial anatomical buttress plate (MABP), and autogenous iliac bone graft through the Watson-Jones approach in the treatment of femoral neck nonunion. Methods This prospective study included 15 patients (12 men and 3 women) with nonunion of femoral neck fracture, who were treated with the DCS and MABP with autogenous iliac bone graft through the Watson-Jones approach. The patients were followed up for an average of 16 months (range, 12–24 months). Results All patients achieved bone healing with an average fracture healing time of 3.4 months (2.8–4.6 months). The Harris score significantly increased from 30 ± 3.9 before the operation to 87.6 ± 7.9 at the last follow-up, and the visual analogue scale significantly decreased from 4 ± 1.3 before the operation to 1 ± 1.7 at the last follow-up. The average limb shortening was reduced from 1.8 cm (range, 0–3.1 cm) before the revision operation to 0.5 cm (range, 0.1–1.3 cm) after the last follow-up. The neck-shaft angle of the injured side was restored from an average of 118° (range, 108–139°) before the revision operation to an average of 132° (range, 127–144°) at the last follow-up. No collapse of the femoral head, wound infections, screw backout, screw or plate breakages, or nerve injury was found. Conclusion TheDCS and MABP with autogenous iliac bone graft through the Watson-Jones approach is an effective option for the treatment of femoral neck nonunion or delayed healing. The translational potential of the article This article shows that the application of DCS and MABP provides a rigid fixation at the fracture site to promote bone graft integration and bone union. This new kind of technique could be one option of Hip conservation procedures, just special for young patients with femoral neck nonunion.
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Affiliation(s)
- Hua Chen
- The Department of Orthopaedic Surgery, Chinese PLA General Hospital (301 Hospital) China
| | - Jia Li
- The Department of Orthopaedic Surgery, Chinese PLA General Hospital (301 Hospital) China
| | - Zuhao Chang
- The Department of Orthopaedic Surgery, Chinese PLA General Hospital (301 Hospital) China
| | - Xiangdang Liang
- The Department of Orthopaedic Surgery, Chinese PLA General Hospital (301 Hospital) China
| | - Peifu Tang
- The Department of Orthopaedic Surgery, Chinese PLA General Hospital (301 Hospital) China
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21
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Abstract
BACKGROUND To assess the effect of fascia iliaca compartment block (FICB) on pain control and morphine consumption in patients with hip fracture. METHODS We searched databases (PubMed, Embase, Cochrane Library) for eligible randomized controlled trials (RCTs) published prior to September 12, 2018. We only included hip fracture patients who received FICB versus placebo for pain control. Risk ratios (RRs), standard mean differences (SMD) and 95% confidence intervals (CI) were determined. Stata 12.0 was used for the meta-analysis. RESULTS Eleven trials involving 937 patients underwent hip fracture were retrieved. FICB significantly decreased the pain intensity at 1-8 h (SMD = -1.03, 95% CI [-1.48, -0.58], P = .000), 12 h (SMD = -1.06, 95% CI [-1.36, -0.75], P = .000), 24 h (SMD = -1.14, 95% CI [-1.66, -0.62], P = .000) and 48 h (SMD = -0.96, 95% CI [-1.33, -0.60], P = .000). Moreover, FICB could reduced the total morphine consumption and the occurrence of nausea (P < .05). There was no significant difference between the pain intensity at 72 h (SMD = 0.11, 95% CI [-0.12, 0.34], P = .355). CONCLUSIONS FICB has a beneficial role in reducing pain intensity and morphine consumption after hip fracture. Moreover, FICB has morphine-sparing effects when compared with a control group. More high-quality RCTs are needed to identify the optimal technique and volume of injectate for FICB.
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Jones JK, Evans BA, Fegan G, Ford S, Guy K, Jones S, Keen L, Khanom A, Longo M, Pallister I, Rees N, Russell IT, Seagrove AC, Watkins A, Snooks HA. Rapid Analgesia for Prehospital hip Disruption (RAPID): findings from a randomised feasibility study. Pilot Feasibility Stud 2019; 5:77. [PMID: 31210961 PMCID: PMC6560881 DOI: 10.1186/s40814-019-0454-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/06/2019] [Indexed: 11/29/2022] Open
Abstract
Background In managing hip fracture, effective pain relief before admission to hospital is difficult without risking side effects. Although emergency departments routinely use fascia iliaca compartment block (FICB), there has been little evaluation of its use by paramedics before hospital admission. We aimed to assess whether a multi-centre randomised trial to evaluate FICB was feasible. Methods Volunteer paramedics used scratchcards to allocate patients with hip fracture at random between FICB and pain relief as usual. Primary outcomes were mortality and quality of life. We also measured adverse events, costs, final diagnosis, length of stay in hospital, pain scores and quality of care and collected qualitative data about acceptability to patients in interviews, and paramedics in focus groups. We pre-specified criteria for deciding whether to progress to a fully powered trial based on the recruitment of paramedics and patients, delivery of FICB, retrieval of outcome data, safety, acceptability, and diagnostic accuracy of hip fracture. Results We effectively met all progression criteria: we recruited 19 paramedics who randomly allocated 71 patients between trial arms between 28 June 2016 and 31 July 2017; 57 (31 experimental arm, 26 usual care arm, 80% overall) retrospectively consented to follow-up. Just over half (17/31) of experimental participants received FICB; all others had contraindications, including nine taking anticoagulants. Four of the 31 participants assigned FICB and six of the 26 assigned usual care died within 6 months of hospital admission. Serious adverse events were also similar: 3/35 experimental versus 4/36 in usual care. Paramedics’ recognition of hip fracture had sensitivity of 49/64 (77%) with a positive predictive value of 46/57 (81%). We received quality of life questionnaires for 30 of 49 patients (61%) at 1 month and 12 of 17 (71%) at 6 months. Patient satisfaction was similar: experimental mean 3.4 (n = 20) versus 3.5 (n = 13) for usual care. Conclusions RAPID met all progression criteria within reasonable limits. As equipoise remains, we plan to undertake a fully powered multi-centre trial to test clinical and cost effectiveness of paramedic-administered FICB at the scene of hip fracture. Trial registration ISRCTN 60065373 sought 5 November 2015. Electronic supplementary material The online version of this article (10.1186/s40814-019-0454-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Greg Fegan
- 1Swansea University Medical School, Swansea, UK
| | - Simon Ford
- Swansea Bay University Health Board, Swansea, UK
| | - Katy Guy
- Swansea Bay University Health Board, Swansea, UK
| | - Sian Jones
- 3Patient and public representative, c/o Swansea University Medical School, Swansea, UK
| | - Leigh Keen
- 4Welsh Ambulance Services NHS Trust, Saint Asaph, UK
| | | | | | - Ian Pallister
- 1Swansea University Medical School, Swansea, UK.,Swansea Bay University Health Board, Swansea, UK
| | - Nigel Rees
- 4Welsh Ambulance Services NHS Trust, Saint Asaph, UK
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Marcantonio AJ, Pace M, Brabeck D, Nault KM, Trzaskos A, Anderson R. Team Approach: Management of Postoperative Delirium in the Elderly Patient with Femoral-Neck Fracture. JBJS Rev 2019; 5:e8. [PMID: 29064845 DOI: 10.2106/jbjs.rvw.17.00026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew J Marcantonio
- Departments of Orthopaedics (A.J.M.), Anesthesiology (M.P.), Hospital Medicine (D.B.), and Rehabilitation Services (A.T.), and Surgical Critical Care Clinical Pharmacy (K.M.N. and R.A.), Lahey Hospital and Medical Center, Burlington, Massachusetts
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Wennberg P, Norlin R, Herlitz J, Sarenmalm EK, Möller M. Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial. Int J Orthop Trauma Nurs 2018; 33:35-43. [PMID: 30876869 DOI: 10.1016/j.ijotn.2018.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 11/17/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures. METHODS A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB. RESULTS The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002). CONCLUSIONS Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.
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Affiliation(s)
- Pär Wennberg
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Centre, Region Örebro, and School of Health Sciences, Örebro University, Sweden.
| | - Rolf Norlin
- Capio Movement, Halmstad, Sweden; Department of Orthopedics, Örebro University Hospital, and Örebro University, Sweden.
| | - Johan Herlitz
- The Centre of Prehospital Research in Western Sweden, University College of Borås, Sweden; The Centre of Prehospital Research in Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | - Margareta Möller
- University Health Care Research Centre, Region Örebro, and School of Health Sciences, Örebro University, Sweden
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25
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26
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Steenberg J, Møller A. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth 2018; 120:1368-1380. [DOI: 10.1016/j.bja.2017.12.042] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/05/2017] [Accepted: 01/14/2018] [Indexed: 11/26/2022] Open
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Gopal ND, Krishnamurthy D. A Clinical Comparative Study of Fascia Iliaca Compartment Block with Bupivacaine and Bupivacaine with Dexmedetomidine for Positioning and Duration of Postoperative Analgesia in Fracture Femur under Spinal Anesthesia. Anesth Essays Res 2018; 12:528-534. [PMID: 29962629 PMCID: PMC6020591 DOI: 10.4103/aer.aer_56_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Positioning fracture femur cases for sub arachnoid block (SAB) is challenging. Fascia iliaca compartment block (FICB) is low skilled, helps positioning, and provides analgesia. Dexmedetomidine as an adjuvant prolongs analgesia. Aims: The aims were to study and compare FICB with bupivacaine and bupivacaine with dexmedetomidine in fracture femur cases with regard to positioning during SAB, duration of analgesia in terms of Visual Analog Scale (VAS), Numerical Rating Scale (NRS), and Patient Satisfaction Score, and assess side effects. Settings and Design: This was a randomized, double-blind, prospective study. Subjects and Methods: Sixty fracture femur patients were divided into two groups as follows: Group A: FICB with injection bupivacaine 0.25% 38 cubic centimeter (cc) + dexmedetomidine 0.5 μg/kg in 2 cc normal saline (NS) and Group B: FICB with injection bupivacaine 0.25% 38 cc + 2 cc NS. Statistical Analysis Used: Data were analyzed using SPSS 22.0 software. Categorical data were processed by frequencies and proportions, whereas continuous data were processed by mean standard deviation. Chi-square test and independent t-test were used as tests of significance, considering P < 0.05 as statistically significant. Results: In Group A, mean VAS score at 5 min (min) was 3.7 ± 0.9 and in Group B it was 4.3 ± 0.7. Similarly, at 15 min, mean VAS score in Group A was 0.4 ± 0.6 and in Group B it was 1.9 ± 0.9. VAS score was significantly high in Group B at 5, 10, and 15 min. Mean time to rescue analgesia in Group A was 838.3 ± 82.7 min and in Group B it was 461.5 ± 36.6 min, which was significant. Conclusion: FICB ensures patient comfort during positioning for SAB and provides postoperative analgesia. Dexmedetomidine significantly prolongs postoperative analgesia.
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Affiliation(s)
| | - Dinesh Krishnamurthy
- Department of Anaesthesiology, Sri Devaraj Urs Medical College, R L Jalappa Hospital, Kolar, Karnataka, India
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28
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Scurrah A, Shiner CT, Stevens JA, Faux SG. Regional nerve blockade for early analgesic management of elderly patients with hip fracture - a narrative review. Anaesthesia 2017; 73:769-783. [DOI: 10.1111/anae.14178] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/27/2022]
Affiliation(s)
- A. Scurrah
- Department of Anaesthetics; St Vincent's Hospital Sydney; NSW Australia
| | - C. T. Shiner
- Department of Rehabilitation and Pain Medicine; St Vincent's Hospital Sydney; NSW Australia
| | - J. A. Stevens
- Department of Anaesthetics; St Vincent's Hospital Sydney; NSW Australia
| | - S. G. Faux
- Department of Rehabilitation and Pain Medicine; St Vincent's Hospital Sydney; NSW Australia
- University of New South Wales; Sydney NSW Australia
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Wennberg P, Andersson H, Wireklint Sundström B. Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature. Int J Orthop Trauma Nurs 2017; 29:16-31. [PMID: 29631852 DOI: 10.1016/j.ijotn.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 09/15/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Pär Wennberg
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Centre for Health Care Sciences, Örebro County Council, School of Health and Medical Sciences, Örebro University, Sweden.
| | - Henrik Andersson
- University of Borås, PreHospen - Centre for Prehospital Research, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Sweden
| | - Birgitta Wireklint Sundström
- University of Borås, PreHospen - Centre for Prehospital Research, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Sweden
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Amin NH, West JA, Farmer T, Basmajian HG. Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy. Geriatr Orthop Surg Rehabil 2017; 8:268-275. [PMID: 29318091 PMCID: PMC5755841 DOI: 10.1177/2151458517734046] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Nirav H Amin
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Travis Farmer
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Hrayr G Basmajian
- Pomona Valley Hospital Medical Center, Department of Orthopedic Surgery, Pomona, CA, USA
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Bandara S, Lynch G, Cooke C, Varghese P, Ward N. Using Care Bundles to Improve Surgical Outcomes and Reduce Variation in Care for Fragility Hip Fracture Patients. Geriatr Orthop Surg Rehabil 2017; 8:104-108. [PMID: 28540116 PMCID: PMC5431405 DOI: 10.1177/2151458516681634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/28/2016] [Accepted: 10/09/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction: Fragility hip fractures constitute a large proportion of orthogeriatric admissions to orthopedic wards. This study looked at reducing variation in care in fragility hip fracture patients using a novel approach with care bundles. The care bundle comprises 5 elements targeted at providing adequate analgesia, early mobilization, improving recognition of delirium, and decreasing rates of urinary infections. Methods: A total of 198 patients who sustained a fragility hip fracture during the intervention period were included in the study. The primary outcome measure was compliance in applying the bundle to the study population, and secondary outcome measures were in-hospital mortality, acute length of stay, delirium and duration of delirium, and urinary tract infections. Results: During the 12-month intervention period, compliance to the bundle of care was 47% (n = 92) based on the “all-or-none” approach. This was 28% higher than the preintervention rate. Overall, there was an increased rate of compliance across all individual elements of the bundle in the intervention group when compared to the preintervention group (P = .01). The most significant clinical result was a 10.5% reduction in “in-hospital mortality” in the intervention group (P < .001). Conclusion: This study demonstrated that the implementation of specific care bundle in patients with fragility hip fracture significantly reduces variation in care.
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Affiliation(s)
- Stephanie Bandara
- Orthopaedic Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Genni Lynch
- Orthopaedic Department, Graduate Certificate in Diabetes Education, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Cameron Cooke
- Orthopaedic Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Paul Varghese
- Geriatric and Rehabilitation Unit, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Nicola Ward
- Orthopaedic Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
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