title: A Prospective Observational Cohort Study on Orthopaedic and Anaesthetic Registrars Performing Femoral Nerve Block on Patients with an Acute Hip Fracture.
abstract: We investigated if a femoral nerve block (FNB) for patients with a proximal femoral fracture (PFF) and administered by an orthopaedic registrar (OR) instead of an anaesthesiology registrar (AR) lowers the lead time to block and reduces the total amount of rescue analgesics during the preoperative phase. 205 patients were included in a prospective observational cohort study. The main outcome variable was rescue analgesics as total intravenous morphine prior to surgery. All results were adjusted for confounding using age, sex, cognitive dysfunction, and ASA classification. The OR group (n= 135) was over 2 hours faster in performing the block compared to the AR group (n= 70) but was nonetheless correlated with an increased amount of rescue analgesics during the study, 2.4 mg morphine (95% CI 0.0-4.9) more compared to the AR group. We found no difference between the groups in the risk of adverse events. We conclude that, for patients with an acute PFF and with morphine consumption as end point, how soon from arrival to hospital the patients receive a FNB is of lesser importance than who is administering it. Based on our results we recommend that emergency hospitals should have routines for anaesthesiologists performing FNB on this frail patient group.
authors.affiliation: Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Thelaus
authors.affiliation: Division of Anesthesiology, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Pettersson
authors.affiliation: Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Gordon
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ferid
authors.identifier: 0000-0001-7082-3414
authors.initials: F
authors.lastname: Krupic
authors.affiliation: Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olof
authors.identifier: 0000-0003-4155-8425
authors.initials: O
authors.lastname: Sköldenberg