Early ultrasound-guided femoral nerve block may reduce need for preoperative opioids in hip fracture

1. In emergency patients with hip fracture and severe pain, patients randomize to receive early ultrasound-guided femoral nerve block (FNB) were observed with reduced preoperative opioid consumption without delaying time to optimal pain control, compared with standard care. 

Evidence Rating Level: 1 (Excellent)

Hip fractures are common painful injuries among elderly patients. 50 to 70% of patients experience severe pain, while 40% may receive sub-optimal pain management. While opioids are frequently employed for initial pain management, the prevalence of adverse effects associated with opioid use underscores the necessity for exploring alternative approaches. This randomized trial aims to assess the impact of early ultrasound-guided FNB, initiated upon diagnosis, on preoperative opioid consumption. Between September and December 2022, patients with a radiographically proven hip fracture and a pain score of ≥ 7 (on a verbal numerical scale ranging from 0 to 10 points) at emergency department triage were identified and randomized in 1:1 ratio to receive ultrasound-guided FNB (n=15) or standard care (n=15). Compared with the standard group, ultrasound-guided FNB reduced median preoperative opioid consumption by 60%, with a 9 morphine milligram intravenous equivalents (MME) reduction (95% CI: 3–14, P < 0.001). The average time for ultrasound-guided FNB was 13.6 ± 6.5 minutes and there was no significant difference in time to pain relief between groups. During the hospital stay, the ultrasound-guided FNB group experienced a 56% reduction in opioid consumption, with a difference of 11.5 MME (95% CI: 0.5–22). Opioid adverse events were 40% lower (95% CI: 5.1–74.9) in the ultrasound-guided FNB group, and no FNB-related adverse effects were reported. Overall, these findings suggest that early in elderly patients with a hip fracture, ultrasound-guided FNB reduces preoperative opioid consumption without delaying the time to pain relief, supporting the adoption of early single ultrasound-guided FNB  performed by trained emergency physicians as an alternative to intravenous opioids.

Click to read the study in European Journal of Emergency Medicine

Image: PD

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