What is the clinical evidence from this study?

Study design: Systematic Review. Population: Hip fracture. Intervention: Peripheral nerve blocks vs. No nerve block or sham block. Primary outcome: Postoperative disorientation (acute confusional state) (RR 0.67, 95% CI 0.50 to 0.90).

April 7, 2021Clinical Orthopaedics and Related ResearchOpen Access

Cochrane in CORR®: Peripheral Nerve Blocks for Hip Fracture Surgery in Adults

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Key result

Peripheral nerve blocks reduced the risk of postoperative disorientation (RR 0.67) and provided superior analgesia compared with no nerve block or sham in adults undergoing hip fracture surgery.

Why the study?

Do peripheral nerve blocks reduce pain and postoperative disorientation in adults undergoing hip fracture surgery?

Study Design

Type

Systematic Review

Structured PICO

Do peripheral nerve blocks reduce pain and postoperative disorientation in adults undergoing hip fracture surgery?

Population

Adults undergoing hip fracture surgery included in 43 randomized controlled trials comparing peripheral nerve blocks to no block or sham.

Intervention

Peripheral nerve blocks (PNBs) including psoas compartment, fascia iliaca, femoral nerve, lateral femoral cutaneous, and obturator blocks during the perioperative period (preoperative, postoperative, or as a supplement to general anesthesia).

Comparator

No nerve block or sham block.

Outcome

Pain scores and acute confusional state (postoperative disorientation).patient reported

Main Result

Relative Risk: 0.67 (95% CI 0.5–0.9)

Number Needed to Treat: 12

Limitations

Substantial variability in PNB techniques, regimens, timing, and surgical techniques among included studies.
Pooling results from all types of surgery may have led to inaccurate estimation of pain reduction.
True incidence of delirium may have been underestimated due to vaguely described definitions and screening methodology.
High clinical heterogeneity and unexplained subgroup analyses.
Substantial variability in PNB techniques, regimens, timing, and surgical technique among included studies.
Variability in time to surgery and anesthetic technique was unaccounted for in subgroup analysis.
True incidence of delirium may have been underestimated due to vague definitions and screening methodology.

Discussion

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Implication

Peripheral nerve blocks provide superior analgesia and reduce the risk of acute confusional state in adults undergoing hip fracture surgery, strongly supporting their addition to multimodal pain management protocols.

Cite This Study

Comeau-Gauthier et al. (2021) conducted a systematic review in Hip fracture. Peripheral nerve blocks vs. No nerve block or sham block was evaluated on Postoperative disorientation (acute confusional state) (RR 0.67, 95% CI 0.50 to 0.90). Peripheral nerve blocks reduced the risk of postoperative disorientation (RR 0.67) and provided superior analgesia compared with no nerve block or sham in adults undergoing hip fracture surgery.

synapsesocial.com/papers/6a9ff04883e2eedfeeba4d61 https://doi.org/10.1097/corr.0000000000001764

View Full Paper

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Cochrane in CORR®: Peripheral Nerve Blocks for Hip Fracture Surgery in Adults

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Cochrane in CORR®: Peripheral Nerve Blocks for Hip Fracture Surgery in Adults

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

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