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Geriatric trauma G-60 falls with hip fractures: A pilot study of acute pain management using femoral nerve fascia iliac blocks

Mangram, Alicia J. MD; Oguntodu, Olakunle F. MD, MS; Hollingworth, Alexandra K. MD; Prokuski, Laura MD; Steinstra, Arleen MSN; Collins, Mary MS; Sucher, Joseph F. MD; Ali-Osman, Francis MD; Dzandu, James K. PhD

Journal of Trauma and Acute Care Surgery: December 2015 - Volume 79 - Issue 6 - p 1067–1072
doi: 10.1097/TA.0000000000000841
WTA Plenary Papers
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BACKGROUND Hip fractures due to falls cause significant morbidity and mortality among geriatric patients. A significant unmet need is an optimal pain management strategy. Consequently, patients are treated with standard analgesic care (SAC) regimens, which deliver high narcotic doses. However, narcotics are associated with delirium as well as gastrointestinal and respiratory failure risks. The purpose of this pilot study was to determine the safety and effectiveness of ultrasound-guided continuous compartmental fascia iliaca block (CFIB) in patients 60 years or older with hip fractures in comparison with SAC alone.

METHODS We performed a retrospective study of 108 patients 60 years or older, with acute pain secondary to hip fracture (2012–2013). Patient variables were age, sex, comorbidities, and Injury Severity Score (ISS). Primary outcome was pain scores; secondary outcomes included hospital length of stay, discharge disposition, morbidity, and mortality. Statistical analysis was performed using (IBM SPSS version 22). For group comparison (SAC vs. SAC + CFIB) median test, repeated-measures analysis and Student’s t test of transformed pain scores were used.

RESULTS Sixty-four patients received SAC only, and 44 patients received SAC + CFIB. Each CFIB placement was successful on first attempt without complications. Median time from emergency department arrival to block placement was 12.5 hours (interquartile range, 4–22 hours). Patients who received SAC + CFIB had significantly lower pain score ratings than patients treated with SAC alone. There were no differences in inpatient morbidity and mortality rates. Patients treated with SAC + CFIB were discharged home more often (p < 0.05).

CONCLUSION Ultrasound-guided CFIB is safe, practical, and readily integrated into the G-60 service for improved pain management of hip fractures. We are now conducting a prospective randomized control trial to confirm our observations.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the John C. Lincoln North Mountain Hospital (A.J.M., A.K.H., L.P., A.S., M.C., J.F.S., F.A.-O., J.K.D.); and Valley Surgical Clinics, LTD (O.F.O.), Phoenix, Arizona.

Submitted: February 20, 2015; Revised: July 17, 2015; Accepted: July 21, 2015, Published online: October 1, 2015.

This study was presented at the 45th annual meeting of the Western Trauma Association, March 1–6, 2015, in Telluride, Colorado.

Address for reprints: Alicia Mangram MD, Honor Health John C. Lincoln Medical Center 250 E. Dunlap Ave. Phoenix, AZ 85020. email: Alicia.Mangram@jcl.com.

© 2015 Lippincott Williams & Wilkins, Inc.