title: Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial.
abstract: To compared outcomes of regional nerve blocks with those of standard analgesics after hip fracture.
  
  
  
  Multisite randomized controlled trial from April 2009 to March 2013.
  
  
  
  Three New York hospitals.
  
  
  
  Individuals with hip fracture (N = 161).
  
  
  
  Participants were randomized to receive an ultrasound-guided, single-injection, femoral nerve block administered by emergency physicians at emergency department (ED) admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours (n = 79) or conventional analgesics (n = 82).
  
  
  
  Pain (0-10 scale), distance walked on Postoperative Day (POD) 3, walking ability 6 weeks after discharge, opioid side effects.
  
  
  
  Pain scores 2 hours after ED presentation favored the intervention group over controls (3.5 vs 5.3, P = .002). Pain scores on POD 3 were significantly better for the intervention than the control group for pain at rest (2.9 vs 3.8, P = .005), with transfers out of bed (4.7 vs 5.9, P = .005), and with walking (4.1 vs 4.8, P = .002). Intervention participants walked significantly further than controls in 2 minutes on POD 3 (170.6 feet, 95% confidence interval (CI) = 109.3-232 vs 100.0 feet, 95% CI = 65.1-134.9; P = .04). At 6 weeks, intervention participants reported better walking and stair climbing ability (mean Functional Independence Measure locomotion score of 10.3 (95% CI = 9.6-11.0) vs 9.1 (95% CI = 8.2-10.0), P = .04). Intervention participants were significantly less likely to report opioid side effects (3% vs 12.4%, P = .03) and required 33% to 40% fewer parenteral morphine sulfate equivalents.
  
  
  
  Femoral nerve blocks performed by emergency physicians followed by continuous fascia iliaca blocks placed by anesthesiologists are feasible and result in superior outcomes.
authors: Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York City, New York.|Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.|James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors: R Sean
authors: RS
authors: Morrison
authors: Maimonides Medical Center, Brooklyn, New York.
authors: Eitan
authors: E
authors: Dickman
authors: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.|James J. Peters Veterans Affairs Medical Center, Bronx, New York.|Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Ula
authors: U
authors: Hwang
authors: Mount Sinai Beth Israel, New York City, New York.
authors: Saadia
authors: S
authors: Akhtar
authors: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Taja
authors: T
authors: Ferguson
authors: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Jennifer
authors: J
authors: Huang
authors: Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York City, New York.|Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Christina L
authors: CL
authors: Jeng
authors: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Bret P
authors: BP
authors: Nelson
authors: Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Meg A
authors: MA
authors: Rosenblatt
authors: Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Jeffrey H
authors: JH
authors: Silverstein
authors: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Reuben J
authors: RJ
authors: Strayer
authors: Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors: Toni M
authors: TM
authors: Torrillo
authors: Mount Sinai Beth Israel, New York City, New York.|University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Knox H
authors: KH
authors: Todd
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005267:Femoral Nerve; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009518:New York; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D020127:Recovery of Function; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: functional recovery; hip fracture; pain