Opioid Usage During Admission in Hip Fracture Patients—The Effect of the Continuous Femoral Nerve Block

Abstract

Introduction:The aim of this study was to investigate whether there was a difference in opioid usage during admission for hip fracture patients with continuous femoral nerve block (cFNB) when compared to patients nonfemoral nerve block (nFNB).Methods and Materials:Patients were identified from the local database on all hip fracture patients admitted to Bispebjerg University Hospital, Denmark. Four hundred fifty-six hip fracture patients were included during the period September 2008 to October 2010.Results:Three hundred sixty-six hip fracture patients had cFNB. The mean time with cFNB was 3.4 days. There were no significant differences in gender, length of stay, time to surgery, mortality rate, in-hospital falls, or resurgery rates during admission between the 2 groups. The nFNB group had an insignificant higher use of morphine as needed during the first 5 days of admission (nFNB: 53.1 mg, 95% confidence interval [CI]: 34.4-71.7; cFNB: 47.7 mg, 95% CI: 40.7-64.3; P = .54) and during the whole admission (cFNB: 34.3 mg, 95% CI: 23.2-45.5; cFNB: 30.3 mg, 95% CI: 26.6-33.0; P = .4). Some 8.47% of the total morphine consumption during admission was morphine as needed for the nFNB group and 9.89% for the cFNB group.Conclusion:Patients with cFNB did only have a marginally lower opioid usage during admission when compared to patients without the block, with no significance between the 2 groups. This could indicate that the cFNB is an ineffective analgesic strategy, especially in the postoperative period, but larger randomized studies are needed in order to clarify this.

Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomised controlled trial

“…One of the perceived benefits to the use of nerve block techniques is the opioid-sparing effect that they provide. Unlike Chaudet et al , 28 we found no difference in common opioid-related side effects (nausea and constipation); Helsø et al 30 found no morphine-sparing effect. The relatively low nausea rates in this study compared with others may explain some of this difference.…”

“…Gille et al 29 used the same infusion regimen as this study and found no difference in pain relief between the catheter group and a systemic analgesia group over 3 days. A retrospective database study from Helsø et al 30 found no difference in morphine consumption during the first 5 days of admission between those given continuous femoral nerve blockade and those without.…”

Is Femoral Nerve Block Superior to Fascia Iliac Block in Hip Surgery? Meta-Analysis of Randomized Controlled Trials

“…Both FNB and FIB were able to substantially minimize opioid consumption in this part, and no significant differences were observed between them. As with previous studies, our findings are in line with those of others [ 29 , 30 ].…”

“…Better pain relief, shorter time for SA, and more stable mean artery pressure with FNB and FICB are well reflected in the satisfaction of the patient perioperatively. The present study is comparable to previous studies that showed that FNB or FICB was more effective in decreasing pain, shortening the time to perform SA, and increasing patient satisfaction [ 30 , 31 ].…”

Optimized clinical practice for superaged patients with hip fracture: significance of damage control and enhanced recovery program

“…Hemodynamic optimization has been advocated for the surgery of superaged patients with hip fracture in recent years. In addition, targeted nerve blocks provide a new approach to enhance recovery after surgery; they include obturator nerve and lateral femoral cutaneous nerve blocks, which will be beneficial for pain relief [26], and iliotibial membrane block, which will help reduce the incidence of postoperative delirium [27].…”