A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture

Trauma Surgery & Acute Care Open

article

Kristin Salottolo¹  Richard Meinig²  Landon Fine³  Michael Kelly²  Robert Madayag⁴  Francie Ekengren⁵  Allen Tanner⁶  Phillip Roman⁴  David Bar-Or⁷ 

[1] Trauma Research Department , St Anthony Hospital & Medical Campus;Orthopedic Services Department , Penrose-St Francis Health Services;Orthopedics Department , Parker Adventist Hospital;Trauma Services Department , St Anthony Hospital & Medical Campus;Trauma Services Department , Wesley Medical Center;Trauma Services Department , Penrose-St Francis Health Services;Trauma Research Department , Swedish Medical Center

关键词: geriatrics;    hip fractures;    nerve blocks;    analgesics;    opioid;   

DOI  :  10.1136/tsaco-2022-000904

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Objectives Until recently, systemic opioids have been standard care for acute pain management of geriatric hip fracture; however, opioids increase risk for delirium. Fascia Iliaca compartment blocks (FICB) may be favored to systemic analgesia for reducing delirium, but this has not been well demonstrated. We evaluated the efficacy of adjunctive FICB versus systemic analgesia on delirium incidence, opioid consumption, and pain scores.Methods This prospective, observational cohort study was performed in patients (55–90 years) with traumatic hip fracture admitted to five trauma centers within 12 hours of injury, enrolled between January 2019 and November 2020. The primary end point was development of delirium, defined by the Confusion Assessment Method tool, from arrival through 48 hours postoperatively, and analyzed with multivariate Firth logistic regression. Secondary end points were analyzed with analysis of covariance models and included preoperative and postoperative oral morphine equivalents and pain numeric rating scale scores.Results There were 517 patients enrolled, 381 (74%) received FICB and 136 (26%) did not. Delirium incidence was 5.4% (n=28) and was similar for patients receiving FICB versus no FICB (FICB, 5.8% and no FICB, 4.4%; adjusted OR: 1.2 (95% CI 0.5 to 3.0), p=0.65). Opioid requirements were similar for patients receiving FICB and no FICB, preoperatively (p=0.75) and postoperatively (p=0.51). Pain scores were significantly lower with FICB than no FICB, preoperatively (4.2 vs 5.1, p=0.002) and postoperatively (2.9 vs 3.5, p=0.04).Conclusions FICB demonstrated significant benefit on self-reported pain but without a concomitant reduction in opioid consumption. Regarding delirium incidence, these findings suggest clinical equipoise and the need for a randomized trial.

【 授权许可】

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