[Analgesia after hip fracture repair in elderly patients: the effect of a continuous femoral nerve block: a prospective and randomised study].
BACKGROUND
The usefulness of peripheral femoral nerve block for pain management after hip fracture has been established. This prospective and randomised study compared the analgesia effect of a continuous femoral nerve block (CF) versus two conventional analgesia procedures after hip fracture.


METHODS
Patients. (n=62) scheduled for surgery under spinal anaesthesia were prospectively included. After surgery, analgesia (48 hours) was randomised: group FC (femoral catheter, anterior paravascular approach, initial bolus followed by continuous infusion of ropivacaine 0.2%), group P (iv 2 g propacetamol/6 hours), group M (sc morphine, 0.05 mg/kg per 4 hour). Intravenous morphine titration was performed, followed by subcutaneous (sc) morphine every 4 hours according to the VAS score. The primary end-point was the morphine requirements. Secondary end-points were VAS score, side effects, and mortality.


RESULTS
Demographic data and surgical procedures were similar between groups. After morphine titration, the VAS pain score did not differ between groups. All patients in-group M received additional morphine. Morphine mean consumption was increased in CF group: 26 mg (5-42) versus P: 8 mg (3-12) (p=0.0001) or M: 19 mg (8-33) (p<0.006) while constipation was decreased in P group vs CF. Percentage of patients requiring no morphine was similar between P (n=6; 28%) and CF (n=6; 28%) and greater than M (n=0; 0%). Hospital discharge, cardiovascular or pulmonary complications and mortality after 6 months showed no statistical difference.


CONCLUSIONS
Continuous femoral nerve block provided limited pain relief after hip fracture did not reduced side effects and induced an expensive cost.
Cuvillon
P
P
Fédération des départements anesthésie douleur et urgences réanimation, hôpital universitaire Caremeau, avenue du Professeur-Debré, 30029 Nîmes, France. philippe.cuvillon@wanadoo.fr <philippe.cuvillon@wanadoo.fr>
Ripart
J
J
Debureaux
S
S
Boisson
C
C
Veyrat
E
E
Mahamat
A
A
Bruelle
P
P
Viel
E
E
Eledjam
J-J
JJ
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D005267:Femoral Nerve; D005592:Fracture Fixation; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D009407:Nerve Block / Q000191:economics / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
D000701:Analgesics, Opioid; D009020:Morphine