Use of Femoral Nerve Block for Acute Hip Fracture Pain Is Feasible in the ER

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.”