title: Ultrasound-guided nerve blocks for intracapsular and extracapsular hip fractures.
abstract: OBJECTIVE
  To compare pain relief between patients with intracapsular and extracapsular hip fractures who received an ultrasound-guided femoral nerve block (USFNB).
  
  
  METHODS
  A multicenter, prospective, randomized, clinical trial.
  
  
  METHODS
  The study was conducted in the emergency departments of 3 academic hospitals located in New York City.
  
  
  METHODS
  Patients aged ≥60 years presenting to the emergency department with hip fracture.
  
  
  METHODS
  A subgroup analysis from a larger data set was conducted of patients with intracapsular and extracapsular hip fractures who received an USFNB. We compared pain scores at baseline and then at 2 and 3 hours after the nerve block was performed, and also assessed pain relief at 2 and 3 hours.
  
  
  RESULTS
  Seventy-seven patients were randomized to receive USFNB, of which 68 had follow-up data at 2 and 3 hours and were included in the data analysis. Thirty-one were diagnosed with intracapsular and 37 with extracapsular hip fractures. In both groups, reductions in pain scores were clinically and statistically significant. In the intracapsular group, mean pain scores decreased from 6.23 to 3.81 (P < .0001) at 2 hours and from 6.23 to 3.87 (P < .0001) at 3 hours. In the extracapsular group, mean pain scores decreased from 6.62 to 3.89 (P < .0001) at 2 hours and from 6.62 to 3.46 (P < .0001) at 3 hours. These differences were similar between the extracapsular and intracapsular groups at 2 hours (P = .92) and at 3 hours (P = .58), thus demonstrating similar reductions in pain in the 2 groups. The differences in pain relief between the intracapsular and extracapsular groups were also similar: 1.61 (confidence interval [CI], 1.14-2.08) vs 1.35 (CI, 0.96-1.75) at 2 hours (P = .39) and 1.68 (CI, 1.21-2.15) vs 1.38 (CI, 0.89-1.87) at 3 hours (P = .38).
  
  
  CONCLUSIONS
  Ultrasound-guided femoral nerve block was equally effective in reducing pain for patients with both intracapsular and extracapsular hip fractures.
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219.
authors.forename: Eitan
authors.initials: E
authors.lastname: Dickman
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219. Electronic address: ipushkar@maimonidesmed.org.
authors.forename: Illya
authors.initials: I
authors.lastname: Pushkar
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219.
authors.forename: Antonios
authors.initials: A
authors.lastname: Likourezos
authors.affiliation: The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
authors.forename: Knox
authors.initials: K
authors.lastname: Todd
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029.
authors.forename: Ula
authors.initials: U
authors.lastname: Hwang
authors.affiliation: Mount Sinai Beth Israel, First Avenue at 16th St, New York, NY 10003.
authors.forename: Saadia
authors.initials: S
authors.lastname: Akhter
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029.
authors.forename: Sean
authors.initials: S
authors.lastname: Morrison
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D005267:Femoral Nerve; D006620:Hip Fractures / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009519:New York City; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000700:Analgesics
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