Geriatric trauma G-60 falls with hip fractures

Mangram, Alicia; Oguntodu, Olakunle F; Hollingworth, Alexandra K.; Prokuski, Laura; Steinstra, Arleen; Collins, Mary Louise Z.; Sucher, Joseph F.; Ali‐Osman, Francis; Dzandu, James K.

doi:10.1097/ta.0000000000000841

Cited by 25 publications

(3 citation statements)

References 9 publications

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“…29,30 Research has shown that FIBs may reduce ORAEs and the LOS. 31,32 We found no difference in ORAEs or LOS between the two groups. Our rates of ORAEs and LOS are comparable to rates reported in the literature.…”

Section: Discussionmentioning

confidence: 53%

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients

Garlich

Pujari

Moak

et al. 2020

J American Geriatrics Society

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BACKGROUND Geriatric hip fracture patients are susceptible to the adverse effects of opioid‐induced analgesia. Fascia iliaca blocks (FIBs) have emerged as an analgesic technique for this population. There are limited data on a preoperative FIB's effect on perioperative opioid intake. We hypothesized that preoperative FIB would reduce perioperative opioid consumption, measured in morphine milliequivalents (MMEs). DESIGN This is a prospective observational study. SETTING A level 1 trauma center in California. PARTICIPANTS From March 2017 to December 2017, patients 65 years and older presenting with a hip fracture received a preoperative FIB and were prospectively observed. This cohort was compared with a historical control. INTERVENTION All prospectively enrolled patients were given FIBs. For a single‐shot FIB, a 30‐ to 40‐mL bolus of 0.25% bupivacaine with 1:200,000 epinephrine was injected. For a continuous FIB, a bolus of 10 to 20 mL of 0.2% bupivacaine was injected, followed by a continuous infusion of 0.2% bupivacaine at 6 mL/h ending on the morning of postoperative Day 1. RESULTS A total of 725 patients were included in this study, with 92 in the prospectively collected cohort. The mean age of this cohort was 84.2 (standard deviation = 8.4) years, and 69.2% were female. Patients who received a preoperative FIB consumed less MME preoperatively, 18.0 (interquartile range = 6.0–44.5) versus 29.5 (interquartile range = 6.0–56.5) (P = .007), with no change in pain scores. No differences were found in postoperative opioid consumption between groups. There was no difference in MME or pain score in patients with dementia. Subgroup analysis based on fracture pattern (femoral neck and intertrochanteric) demonstrated a significant decrease in preoperative MME consumption in femoral neck fractures only, 12.0 (interquartile range = 5.0–24.0) versus 29.0 (interquartile range = 12.0–59.0) (P < .001). CONCLUSION FIBs reduce preoperative opioid intake and have low rates of opioid‐related adverse events in geriatric hip fracture patients. LEVEL OF EVIDENCE The level of evidence was II.

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Section: Discussionmentioning

confidence: 53%

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients

Garlich

Pujari

Moak

et al. 2020

J American Geriatrics Society

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“…24,27 This is in contrast to other studies which have found no difference in length of stay comparing FI block with other pain control regimens. 28–30 This study found a decreased length of stay in patients undergoing FI block. Hecht et al 31 have shown that delirium and time to surgery have the largest influence on length of stay.…”

Section: Discussionmentioning

confidence: 62%

Fascia Iliaca Blocks Performed in the Emergency Department Decrease Opioid Consumption and Length of Stay in Patients with Hip Fracture

Kolodychuk¹,

Krebs²,

Stenberg³

et al. 2022

Journal of Orthopaedic Trauma

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“… 42 Dulaney-Cripe et al and Mangram et al demonstrated that continuous FICB through an indwelling catheter produced decreased opioid usage and shorter length of stay in the hospital. 43 , 44 Taken together, these results show that FICB reduces postoperative pain in hip fracture patients, thereby decreasing opioid consumption ( Table 3 ). Decreased opioid consumption may reduce the incidence of delirium in susceptible patients leading to shorter mean hospital stays with fewer complications.…”

Section: Postoperative Pain Control With Ficbmentioning

confidence: 64%

Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy

Amin

West

Farmer

et al. 2017

Geriatr Orthop Surg Rehabil

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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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Geriatric trauma G-60 falls with hip fractures

Abstract: Therapeutic study, level IV.

Cited by 25 publications

References 9 publications

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients

Fascia Iliaca Blocks Performed in the Emergency Department Decrease Opioid Consumption and Length of Stay in Patients with Hip Fracture

Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy

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