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3906
Efficacy of single shot femoral nerve blocks in fragility hip fractures: a retrospective cohort study
Fri, April 7, 4:15-5:45 pm
Salon 5

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Efficacy of single shot femoral nerve blocks in fragility hip fractures: a retrospective cohort study
E Harmon, MD; D Chang, MD; F Dai, PhD, MS; N Sukumar, MS; J Li, MD

Yale University and Yale New Haven Hospital

Introduction

•Hip fractures are common and associated with high rates of morbidity and mortality for geriatric patients.
•Femoral nerve block use for perioperative pain control for all subtypes of hip fractures has become increasingly popular
•Both pain scores improved and opioid use is reduced with femoral nerve block use
•To date, there are no studies that compare the efficacy of femoral nerve blocks among different hip fracture subtypes.

Objectives

•To compare pre- and post- femoral nerve block pain scores in patients presenting with low impact fragility hip fractures (all subtypes)
•To compare pre- and post-block opioid requirements across all subtypes 

Methods

•Retrospective cohort study of 159 patients presenting with hip fractures (N=131 included for data analysis) at a level one trauma hospital
•Single shot femoral nerve blocks performed upon radiological confirmation of hip fractures
•Pre-block pain scores and opoid use obtained prior to block placement
•Post-block pain scores and opioid requirements obtained up to 24 hours after block placement or immediately prior to surgery
•Wilcoxon signed rank test data evalaution

Results 

•Significantly greater reduction in pain score observed in patients with subcapital femoral neck fractures (p=0.009) and transcervical femoral neck fractures (p=0.01)
•Intracapsular fractures had a significantly larger reduction in pain scores after femoral nerve block compared with extracapsular fractures (p=0.006)
•No statistically significant difference in morphine use pre- and post-block seen within fracture subtypes, between fractures subtypes, or between intracapsular and extracapsular types 

Conclusions 

•Femoral nerve blocks provide statistically significant pain score reduction when preformed in patients with femoral neck/intracapsular fractures
•Possible cephalad spread of local anesthetic responsible for significant pain relief is femoral neck fracture patients
•Femoral capsule is densely innervated by the femoral nerve anteriorly, which may explain the greater pain score reduction in intracapsular fractures 


 

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