title: Geriatric trauma G-60 falls with hip fractures: A pilot study of acute pain management using femoral nerve fascia iliac blocks.
abstract: BACKGROUND
  Hip fractures due to falls cause significant morbidity and mortality among geriatric patients. A significant unmet need is an optimal pain management strategy. Consequently, patients are treated with standard analgesic care (SAC) regimens, which deliver high narcotic doses. However, narcotics are associated with delirium as well as gastrointestinal and respiratory failure risks. The purpose of this pilot study was to determine the safety and effectiveness of ultrasound-guided continuous compartmental fascia iliaca block (CFIB) in patients 60 years or older with hip fractures in comparison with SAC alone.
  
  
  METHODS
  We performed a retrospective study of 108 patients 60 years or older, with acute pain secondary to hip fracture (2012-2013). Patient variables were age, sex, comorbidities, and Injury Severity Score (ISS). Primary outcome was pain scores; secondary outcomes included hospital length of stay, discharge disposition, morbidity, and mortality. Statistical analysis was performed using (IBM SPSS version 22). For group comparison (SAC vs. SAC + CFIB) median test, repeated-measures analysis and Student's t test of transformed pain scores were used.
  
  
  RESULTS
  Sixty-four patients received SAC only, and 44 patients received SAC + CFIB. Each CFIB placement was successful on first attempt without complications. Median time from emergency department arrival to block placement was 12.5 hours (interquartile range, 4-22 hours). Patients who received SAC + CFIB had significantly lower pain score ratings than patients treated with SAC alone. There were no differences in inpatient morbidity and mortality rates. Patients treated with SAC + CFIB were discharged home more often (p < 0.05).
  
  
  CONCLUSIONS
  Ultrasound-guided CFIB is safe, practical, and readily integrated into the G-60 service for improved pain management of hip fractures. We are now conducting a prospective randomized control trial to confirm our observations.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: From the John C. Lincoln North Mountain Hospital (A.J.M., A.K.H., L.P., A.S., M.C., J.F.S., F.A.-O., J.K.D.); and Valley Surgical Clinics, LTD (O.F.O.), Phoenix, Arizona.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Mangram
authors.forename: Olakunle F
authors.initials: OF
authors.lastname: Oguntodu
authors.forename: Alexandra K
authors.initials: AK
authors.lastname: Hollingworth
authors.forename: Laura
authors.initials: L
authors.lastname: Prokuski
authors.forename: Arleen
authors.initials: A
authors.lastname: Steinstra
authors.forename: Mary
authors.initials: M
authors.lastname: Collins
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sucher
authors.forename: Francis
authors.initials: F
authors.lastname: Ali-Osman
authors.forename: James K
authors.initials: JK
authors.lastname: Dzandu
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D005267:Femoral Nerve; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010865:Pilot Projects; D012042:Registries; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
chemical_list: D000700:Analgesics