Ultrasound-Guided Femoral Nerve Block in Geriatric Patients with Hip Fracture in the Emergency Department

Journal of Clinical Medicine

Eric H. Chou¹  Kuan-Fu Chen²  Kuo-Chih Chen³  Chien-Ting Chen⁴  Mei-Wen Chen⁴  Kar Mun Cheong⁵  Yi-Kung Lee⁵  Yung-Cheng Su⁵  Tou-Yuan Tsai⁵  Su Weng Chau⁵  Ming-Chieh Shih⁶  Jen-Tang Sun⁷ 

[1] Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA;Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 62224, Taiwan;Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;Institute for Medical Engineering and Science, MIT, Cambridge, MA 02142, USA;School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;

关键词: opioid;    pain;    regional anesthesia;    ultrasound;    emergency department;   

DOI  :  10.3390/jcm11102778

来源: DOAJ

【 摘 要 】

Background and Objectives: Systemic analgesics, including opioids, are commonly used for acute pain control in traumatic hip fracture patients in the emergency department (ED). However, their use is associated with high rates of adverse reactions in the geriatric population. As such, the aim of this study was to investigate the impact of lidocaine-based single-shot ultrasound-guided femoral nerve block (USFNB) on the standard care for acute pain management in geriatric patients with traumatic hip fracture in the ED. Methods: This retrospective, single-center, observational study included adult patients aged ≥60 years presenting with acute traumatic hip fracture in the ED between 1 January 2017 and 31 December 2020. The primary outcome measure was the difference in the amount of opioid use, in terms of morphine milligram equivalents (MME), between lidocaine-based single-shot USFNB and standard care groups. The obtained data were evaluated through a time-to-event analysis (time to meaningful pain relief), a time course analysis, and a multivariable analysis. Results: Overall, 607 adult patients (USFNB group, 66; standard care group, 541) were included in the study. The patients in the USFNB group required 80% less MME than those in the standard care group (0.52 ± 1.47 vs. 2.57 ± 2.53, p < 0.001). The multivariable Cox proportional hazards regression models showed that patients who received USFNB achieved meaningful pain relief 2.37-fold faster (hazard ratio (HR) = 2.37, 95% confidence intervals (CI) = 1.73–3.24, p < 0.001). Conclusions: In geriatric patients with hip fractures, a lidocaine-based single-shot USFNB can significantly reduce opioid consumption and provide more rapid and effective pain reduction.

【 授权许可】

Unknown