Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial
| Autor: | Reuben J. Strayer, Eitan Dickman, Taja Ferguson, Knox H. Todd, Meg A. Rosenblatt, Bret P. Nelson, Jeffrey H. Silverstein, Saadia Akhtar, Toni M. Torrillo, R. Sean Morrison, Christina L. Jeng, Jennifer Huang, Ula Hwang |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty New York Article law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Femoral nerve law medicine Humans Pain Management 030212 general & internal medicine Ultrasonography Interventional Aged Pain Measurement Aged 80 and over Morphine sulfate Pain Postoperative Hip fracture Hip Fractures business.industry Nerve Block Recovery of Function Emergency department Middle Aged medicine.disease Functional Independence Measure Confidence interval Treatment Outcome Opioid Anesthesia Physical therapy Female Geriatrics and Gerontology business Femoral Nerve 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of the American Geriatrics Society. 64:2433-2439 |
| ISSN: | 0002-8614 |
| DOI: | 10.1111/jgs.14386 |
| Popis: | Objectives To compared outcomes of regional nerve blocks with those of standard analgesics after hip fracture. Design Multisite randomized controlled trial from April 2009 to March 2013. Setting Three New York hospitals. Participants Individuals with hip fracture (N = 161). Intervention Participants were randomized to receive an ultrasound-guided, single-injection, femoral nerve block administered by emergency physicians at emergency department (ED) admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours (n = 79) or conventional analgesics (n = 82). Measurements Pain (0-10 scale), distance walked on Postoperative Day (POD) 3, walking ability 6 weeks after discharge, opioid side effects. Results Pain scores 2 hours after ED presentation favored the intervention group over controls (3.5 vs 5.3, P = .002). Pain scores on POD 3 were significantly better for the intervention than the control group for pain at rest (2.9 vs 3.8, P = .005), with transfers out of bed (4.7 vs 5.9, P = .005), and with walking (4.1 vs 4.8, P = .002). Intervention participants walked significantly further than controls in 2 minutes on POD 3 (170.6 feet, 95% confidence interval (CI) = 109.3-232 vs 100.0 feet, 95% CI = 65.1-134.9; P = .04). At 6 weeks, intervention participants reported better walking and stair climbing ability (mean Functional Independence Measure locomotion score of 10.3 (95% CI = 9.6-11.0) vs 9.1 (95% CI = 8.2-10.0), P = .04). Intervention participants were significantly less likely to report opioid side effects (3% vs 12.4%, P = .03) and required 33% to 40% fewer parenteral morphine sulfate equivalents. Conclusion Femoral nerve blocks performed by emergency physicians followed by continuous fascia iliaca blocks placed by anesthesiologists are feasible and result in superior outcomes. |
| Databáze: | OpenAIRE |
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