SPING Block Analgesia in Non-Operative Management of Proximal Femur Fractures in Older Adults Living with Frailty: A Retrospective Cohort Study

Q: What are the key findings of this study?

SPING block reduced median pain scores from 4 to 0 and median opioid use from 15 to /day in frail older adults with proximal femur fractures.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Proximal femur fractures (PFFs) in older adults living with frailty receiving non-operative management (n=68). Intervention: Spinal Phenol IN Glycerol (SPING) block. Primary outcome: Pain intensity (Numeric Rating Scale [NRS] score before vs. immediately after SPING block) (p=< 0.001).

Q: What does this research mean for the field?

Spinal Phenol IN Glycerol (SPING) block provides effective pain relief and significantly reduces opioid consumption while enabling mobility in frail older adults managed non-operatively for proximal femur fractures. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the patient, safety, and process outcomes of Spinal Phenol IN Glycerol (SPING) block analgesia in frail older adults receiving non-operative management for proximal femur fractures.

Miriam W. A. van der Velden; Thamar Kroes; Nick J. G. Visschers; F Loos; Pleun Janssens; Bart Spaetgens; Miriam C. Faes; M.H.J. van den Beuken-van Everdingen; Arnela Suman

doi:10.3390/geriatrics10010010

January 10, 2025GeriatricsOpen Access

SPING Block Analgesia in Non-Operative Management of Proximal Femur Fractures in Older Adults Living with Frailty: A Retrospective Cohort Study

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Key result

SPING block is linked to a ~4-point pain score reduction in frail hip fracture patients.

P<0.001
n=68

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Why the study?

Effective pain management minimizing opioid use is critical in non-operative management of proximal femur fractures in frail older adults.

Does Spinal Phenol IN Glycerol (SPING) block reduce pain intensity and opioid consumption while enabling mobility in frail older adults with proximal femur fractures receiving non-operative management?

Key Points

To evaluate the patient, safety, and process outcomes of Spinal Phenol IN Glycerol (SPING) block analgesia in frail older adults receiving non-operative management for proximal femur fractures.
Retrospective cohort study conducted at a suburban teaching hospital including 68 frail older adults with proximal femur fractures treated with SPING block between March 2021 and June 2024.
Data extracted from Electronic Patient Records on pain intensity, opioid consumption, mobility, adverse events, discharge disposition, and survival, analyzed using the Wilcoxon Signed Rank test.
SPING block was effective in 93% of patients, significantly lowering median pain scores from 4 (IQR 3–5) to 0 (IQR 0–1, p < 0.001) and median opioid consumption from 15 mg/day (IQR 4–30) to 0 mg/day (IQR 0–0, p < 0.001).
Within 24 hours post-treatment, 84% of patients could sit upright and 44% performed bed-to-chair transfers; median discharge time was 1 day (IQR 0–3) with a median survival of 13 days (IQR 7–44).
Reported in-hospital complications included hypotension in 6%, fecal incontinence in 4%, urinary incontinence in 3%, and fever in 3% of patients, with 81% overall satisfaction among patients or their representatives.

Study Design

Type

Cohort (n=68)

Multicenter

No

Structured PICO

Does Spinal Phenol IN Glycerol (SPING) block reduce pain intensity and opioid consumption while enabling mobility in frail older adults with proximal femur fractures receiving non-operative management?

P

Population

68 frail older adults (median age 89, 63% female) with radiologically confirmed proximal femur fractures undergoing palliative non-operative management, followed for a median of 146 days.

E

Exposure

Spinal Phenol IN Glycerol (SPING) block consisting of a single-shot intrathecal administration of 0.8 mL of a 10% phenol–glycerol mixture in a lateral position, ideally within 24 hours of emergency department admission, with immediate discontinuation of slow-release opioids.

O

Outcome

Pain intensity (Numeric Rating Scale [NRS] before vs. immediately after treatment, over the first 24 hours, and at discharge), daily opioid consumption (Morphine Milligram Equivalents [MME] before vs. post-treatment), and mobility (ability to sit upright within 24 hours and mobility level at discharge).patient reported

Main Result

Absolute Event Rate: 0% vs 4%

p-value: p=< 0.001

In frail older adults opting for palliative non-operative management of proximal femur fractures, a single-shot SPING block provides rapid, definitive pain relief, eliminates opioid requirements in most patients, and facilitates hospital discharge within a median of one day.

Limitations

Single-center, retrospective, and observational design without a control group
Heterogeneous study population selected via shared decision-making may have introduced unknown bias
Inability to distinguish pain scores during movement versus rest retrospectively
High prevalence of cognitive impairment or dementia (68%), which may have led to underreporting of pain and overestimation of effectiveness
Rapid discharge resulted in the absence of comprehensive data on long-term care needs, pain control, and complications, with incomplete mortality data
Single-center, retrospective, observational design without a control group
Patient selection based on shared decision-making resulted in a heterogeneous population and potential selection bias
Inability to retrospectively distinguish pain scores during movement versus rest
High prevalence of cognitive impairment or dementia (68%) may have impaired pain reporting and overestimated block efficacy
Rapid hospital discharge and retrospective design hindered comprehensive monitoring of minor complications, pre-existing conditions, and complete mortality data

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Implication

May support SPING block for pain control in non-operative femur fractures; leaves open randomized confirmation of mobility and safety.

Abstract

Background/Objectives: Spinal Phenol IN Glycerol (SPING) block is a novel palliative pain treatment for the non-operative management of proximal femur fractures (PFFs) in older adults living with frailty. Effective pain management that aligns with patient preferences and minimizes opioid use is critical in this setting. This study evaluated the patient, safety, and process outcomes of SPING block in this population. Methods: A retrospective cohort study was conducted in a suburban teaching hospital from March 2021 to June 2024, which included sixty-eight older adults living with frailty that suffered from a PFF and received SPING block. Data were collected from the Electronic Patient Records. The patient living situation was visualized with a Sankey diagram. Changes in pain scores and opioid use were assessed using the Wilcoxon Signed Rank test. Results: The median patient age was 89 years (Interquartile range (IQR) 83–92). Most were severely or terminally ill (American Society of Anesthesiologists (ASA) ≥ 4, 72%) and had cognitive impairment or dementia (68%). SPING block was effective in 93% of patients, significantly reducing median pain scores (4 [IQR 3–5] to 0 [IQR 0–1], p < 0.001) and opioid use (15 mg/day [IQR 4–30] to 0 mg/day [IQR 0–0], p < 0.001). Within 24 h, 84% could sit upright and 44% could transfer between their bed and chair. The median time to discharge was one day (IQR 0–3), with a median survival of 13 days (IQR 7–44). Conclusions: This study supports SPING block as a viable option for older adults living with frailty suffering from a PFF who opt for non-operative management in a palliative setting. SPING block for PFFs in a palliative setting offers effective pain relief, reduces opioid use, and enables mobility for older adults living with frailty. Follow-up is essential to monitor efficacy and safety. Prospective studies are needed to confirm these findings.

Discussion

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Cite This Study

Velden et al. (2025) conducted a cohort in Proximal femur fractures (PFFs) in older adults living with frailty receiving non-operative management (n=68). Spinal Phenol IN Glycerol (SPING) block was evaluated on Pain intensity (Numeric Rating Scale [NRS] score before vs. immediately after SPING block) (p=< 0.001). SPING block reduced median pain scores from 4 to 0 and median opioid use from 15 to /day in frail older adults with proximal femur fractures.

synapsesocial.com/papers/6a8b1ee8b676b7d1a2fb5723 https://doi.org/10.3390/geriatrics10010010

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SPING Block Analgesia in Non-Operative Management of Proximal Femur Fractures in Older Adults Living with Frailty: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

SPING Block Analgesia in Non-Operative Management of Proximal Femur Fractures in Older Adults Living with Frailty: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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