Key result
Ultrasound-guided femoral nerve block reduced opioid use compared to standard care (0.52 vs 2.57 MME; P<0.001) and achieved pain relief faster (HR 2.37; 95% CI 1.73-3.24).
Why the study?
Systemic analgesics like opioids carry high rates of adverse reactions in geriatric patients with traumatic hip fractures, prompting evaluation of lidocaine-based single-shot ultrasound-guided femoral nerve block.
Does lidocaine-based single-shot ultrasound-guided femoral nerve block reduce opioid use and improve pain relief in geriatric patients with hip fracture in the emergency department?
Observational (n=607)
No
Does lidocaine-based single-shot ultrasound-guided femoral nerve block reduce opioid use and improve pain relief in geriatric patients with hip fracture in the emergency department?
Absolute Event Rate: 0.52% vs 2.57%
p-value: p=<0.001
Lidocaine-based single-shot ultrasound-guided femoral nerve block significantly reduces opioid consumption and provides faster pain relief in geriatric patients with hip fractures in the emergency department.
Supports consideration in ED hip fracture protocols; hypothesis-generating and requires RCTs before practice change.
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.
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Tsai et al. (2022) conducted an observational in acute traumatic hip fracture (n=607). lidocaine-based single-shot ultrasound-guided femoral nerve block (USFNB) vs. standard care was evaluated on difference in the amount of opioid use, in terms of morphine milligram equivalents (MME) (p=<0.001). Ultrasound-guided femoral nerve block reduced opioid use compared to standard care (0.52 vs 2.57 MME; P<0.001) and achieved pain relief faster (HR 2.37; 95% CI 1.73-3.24).
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