Femoral Nerve Blocks versus Standard Pain Control for Hip Fractures: A Retrospective Comparative Analysis

Geizhals, Solomon; Shou, You; Greenstein, Josh; Hahn, Barry; Chacko, Jerel; Basile, Joseph; Marino, Joseph

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Clin Exp Emerg Med > Accepted Articles

Original Article

doi: https://doi.org/10.15441/ceem.23.112 [Accepted]

Femoral Nerve Blocks versus Standard Pain Control for Hip Fractures: A Retrospective Comparative Analysis

Solomon Geizhals¹, You Shou², Josh Greenstein¹

¹Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY
²Department of Anesthesiology, Long Island Jewish Valley Stream, Valley Stream, NY

Correspondence Josh Greenstein Fax: 718-226-9158, Email: jgreenstein1@northwell.edu

Received: August 22, 2023. Revised: November 21, 2023. Accepted: November 27, 2023. Published online: January 29, 2024.

ABSTRACT

Introduction
Pain control for hip fractures is often achieved via intravenous opioids. However, opioids can have dangerous adverse effects, including respiratory depression and delirium. Peripheral nerve blockade is an alternative option for pain control, which reduces the need for opioid analgesia. The purpose of this study was to compare the use of femoral nerve blocks versus standard pain control for patients with hip fractures.
Methods
This retrospective study included adult patients presenting to the emergency department (ED) with isolated hip fractures between April 2021 and September 2022. The intervention group included all patients who received a femoral nerve block during this time. An equivalent number of patients who received standard pain control during that period were randomly selected to represent the control group. The primary outcome was pre-operative opioid requirement, assessed by morphine milligram equivalents (MME).
Results
During the study period, 90 patients were identified in each treatment group. Mean pre-operative MME was 10.3 (95% confidence interval [CI]: 7.4–13.2 MME) for the intervention group and 14.0 (95% CI: 10.2–17.8) for the control group (P=0.13). Patients who received a femoral nerve block also had shorter time from ED triage to hospital discharge (7.2 days, 95% CI: 6.2–8.0 days) than patients who received standard care (8.6 days, 95% CI: 7.2–10.0 days). Still, this difference was not statistically significant (P=0.09).
Conclusions
Femoral nerve blockade is a safe and effective alternative to opioids for pain control in patients with hip fractures.

Keywords: Hip fracture; nerve block; analgesia; ultrasound