The use of femoral nerve block in the Emergency Room (ER) to help quell the pain caused by acute hip fracture is feasible in older adults, according to a study presented here at the 2015 Annual Scientific Meeting of the American Geriatrics Society (AGS).
The development will help in early pain relief following a fall, and may provide better outcomes following discharge.
Fred Ko, MD, Icahn School of Medicine, New York, New York, and colleagues conducted a single-blind, randomised trial at 3 ERs in New York City from July 2009 to August 2014.
The study compared femoral nerve blocks (n = 72) performed by emergency physicians with usual care (n = 81), which involves conventional opioid therapy.
The femoral nerve block consisted of a single injection of 20 mL of 0.5% bupivacaine. Intravenous opioids were permitted as needed.
The primary outcomes were self-reported pain intensity using the Numerical Rating Scale and pain relief on a 6-point ordinal scale. Other outcomes were perioperative hospital and post-discharge outcomes.
Mean patient-reported pain intensity scores 2 hours after arrival to the ER was 3.9 in those receiving femoral nerve block and 5.4 in those receiving conventional opioid therapy (P = .004). The respective values 3 hours post-arrival were 3.6 and 5.3 (P < .001).
The mean hospital stay was similar in those treated conventionally (6.2 days; range, 2-32 days) and with femoral nerve block (6.4 days; range, 0-42 days). Severe opioid-related side effects occurred in 12.4% of the conventionally-treated patients and in 3% of those receiving femoral nerve block.
Peri-operatively, the assessed 2-minute walk distance was significantly longer in patients who received femoral nerve block (mean 170.6 feet; range, 109.3-232.0 feet) than those treated conventionally (mean 100.0 feet; range, 65.1-134.9 feet; P = .04).
“In patients with acute hip fracture, use of ER-administered femoral nerve block and subsequent anaesthesia provide superior analgesic outcomes in the acute and post-operative periods when compared to conventional opioid therapy,” said Dr. Ko. “Opioid sparing and non-systematic regional anaesthetic techniques may be an effective analgesic option in older patients.”