A Comparison in Outcomes of Preoperative Single-shot versus Continuous Catheter Fascia Iliaca Regional Anesthesia in Geriatric Hip Fracture Patients

Stephen R Stephan; John M Garlich; Eytan M Debbi; Christopher R Johnson; Landon S Polakof; Ali S Noorzad; Zachary B Moak; Dheeraj R Yalamanchili; Samuel K Stephenson; Kapil K Anand; Carol A Lin; Milton T M Little; Charles N Moon

doi:10.1016/j.injury.2020.04.024

A Comparison in Outcomes of Preoperative Single-shot versus Continuous Catheter Fascia Iliaca Regional Anesthesia in Geriatric Hip Fracture Patients

Injury. 2020 Jun;51(6):1337-1342. doi: 10.1016/j.injury.2020.04.024. Epub 2020 Apr 19.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Stephen.Stephan@cshs.org.
² Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: John.Garlich@cshs.org.
³ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Eytan.Debbi@cshs.org.
⁴ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Christopher.Johnson2@cshs.org.
⁵ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Landon.Polakof@cshs.org.
⁶ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Ali.Noorzad@cshs.org.
⁷ Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Zachary.Moak@cshs.org.
⁸ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Dheeraj.Yalamanchili@cshs.org.
⁹ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Samuel.Stephenson@cshs.org.
¹⁰ Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Kapil.Anand@cshs.org.
¹¹ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Carol.Lin@cshs.org.
¹² Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Milton.Little@cshs.org.
¹³ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA. Electronic address: Charles.Moon@cshs.org.

PMID: 32327234
DOI: 10.1016/j.injury.2020.04.024

Abstract

Background: Fascia iliaca nerve blocks relieve pain in geriatric hip fracture patients and can be administered via a single-shot or continuous catheter. We compared perioperative opioid consumption and pain scores between these two blocks.

Methods: We performed a prospective, observational cohort study, including geriatric hip fracture patients who received a preoperative block. We compared morphine milligram equivalent (MME) consumption and visual analog scale (VAS) pain scores between single-shot and continuous fascia iliaca blocks at multiple time points: preoperative and on postoperative (POD) day 0, 1, and 2. We compared the change in preoperative total and hourly opioid consumption before and after block placement within and between groups. Secondary outcomes included opioid related adverse events, length of stay, and readmission rates.

Results: 107 patients were analyzed, 66 received a single-shot and 41 a continuous block. No significant differences were found between both blocks at any time point for median MME consumption or pain scores. MME [IQR]: preoperative 20.5 [6.0,48.8] vs. 24.0 [8.8,48.0], p=0.95; POD0 6.0 [0.0,18.6] vs. 10.0 [0.0,14.0], p=0.52; POD1 12.0 [0.0,30.0] vs. 18.0 [5.0,24.0], p=0.69; POD2 6.0 [0.0,21.2] vs. 12.0 [0.0,24.0], p=0.54. VAS [IQR]: preoperative 4.0 [2.2,5.3] vs. 4.6 [3.2,5.3], p=0.34; POD0 1.3 [0.0,3.7] vs. 2.5 [0.0,3.6], p=0.73; POD1 2.9 [1.7,4.4] vs. 3.7 [1.5,4.7], p=0.59; POD2 2.4 [1.0,4.4] vs. 3.3 [1.9,4.2], p=0.18. Preoperative MME/hr significantly decreased after the block for both groups: 1.05 [0.0,2.2] to 0.0 [0.0,0.0], p < 0.001; 1.4 [0.6,3.1] to 0.0 [0.0,0.1], p < 0.001. The reduction in MME/hr between groups was not significantly different: 0.9 [0.0,1.9] vs. 1.4 [0.6,3.1], p = 0.067. We found no significant differences in secondary outcomes between groups.

Conclusions: We report no differences in opioid use and pain scores between single-shot and continuous catheter fascia iliaca nerve blocks. Both blocks similarly reduce preoperative opioid consumption.

Keywords: Fascia iliaca regional anesthesia; Geriatric; Hip fracture; Opioid use; Pain; Regional anesthesia.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Analgesics, Opioid / therapeutic use
Anesthesia, Conduction / methods*
Female
Hip Fractures / surgery*
Humans
Male
Nerve Block / methods*
Pain Management / methods*
Pain Measurement
Pain, Postoperative / drug therapy
Prospective Studies
Ultrasonography, Interventional

Substances

Analgesics, Opioid