Regional Anesthesia for Hip Fractures in the Emergency Department

  • Shane Hnatusko Emergency Medicine Resident - OSU Medical Center
  • Cass Cherry Department of Emergency Medicine - OSU Medical Center
  • Kelly Murray Department of Emergency Medicine - OSU Medical Center
  • Anastasia Fisher Department of Emergency Medicine - OSU Medical Center
  • Gavin Gardner Department of Emergency Medicine - OSU Medical Center

Abstract

Regional Anesthesia for Hip Fractures in the Emergency Department

Abstract

Hip fractures represent a major healthcare concern for adults as every year over 300,000 people, age 65 and older, are hospitalized for hip fractures. Similarly, hip fractures present a significant issue in terms of reduced functionality, morbidity, and mortality, as the one-year mortality rate following a hip fracture can be as high as 58%. Initial pain control for hip fractures almost always begins in the emergency department (ED). Pain control for hip fractures has traditionally been accomplished by parental opioid medications. However, with recognition of the many adverse effects and the heightened awareness of the opioid crisis, there has been a shift towards multimodal pain control for acute pain in the ED. Many clinicians have begun to adopt the practice of using regional anesthesia in the ED for hip fractures. Despite this growing trend, there have been no large-scale randomized clinical trials to provide a universal policy or standard of care statement. Therefore, this literature review was designed to provide an encompassing evaluation of the current literature investigating the potential use, efficacy, and safety of regional nerve blocks, when compared to traditional parenteral pain medication, for hip fractures in the ED. After evaluating six relevant articles, we have gained insight that regional anesthesia may offer a more rapid, efficacious, and safe alternative to pain control in patients with hip fractures when compared to traditional opioids, NSAIDs, and other modalities of pain control. Although the articles being reviewed demonstrate to be smaller studies with inherent risk of bias and other limitations, based on the current composition of data, it seems that there is moderate support for the use of regional nerve blocks in the ED, as this may improve many clinically relevant and patient oriented aspects of ED hip fracture care.

Published
2020-07-06
Section
Medical