Continuous Femoral Nerve Catheters Decrease Opioid-Related Side Effects and Increase Home Disposition Rates Among Geriatric Hip Fracture Patients. Issue 6 (June 2017)

• Record Type: Journal Article
• Authors: Arsoy, Diren; Gardner, Michael J.; Amanatullah, Derek F.; Huddleston, James I.; Goodman, Stuart B.; Maloney, William J.; Bishop, Julius A.
• Is Part Of: Journal of orthopaedic trauma. Volume 31:Issue 6(2017)
• Publication Date: 2017-06
• Subjects: geriatric hip fracture -- regional anesthesia -- femoral nerve block -- femoral nerve catheter; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000854
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objective: To evaluate the effect of continuous femoral nerve catheter (CFNC) for postoperative pain control in geriatric proximal femur fractures compared with standard analgesia (SA) treatment. Design: Retrospective comparative study. Setting: Academic Level 1 trauma center. Patients/Participants: We retrospectively identified 265 consecutive geriatric hip fracture patients who underwent surgical treatment. Intervention: One hundred forty-nine patients were treated with standard analgesia without nerve catheter whereas 116 patients received an indwelling CFNC. Main Outcome Measurement: Daily average preoperative and postoperative pain scores, daily morphine equivalent consumption, opioid-related side effects and discharge disposition. Results: Patients with CFNC patients reported lower average pain scores preoperatively (1.9 ± 1.7 for CFNC vs. 4.7 ± 2 for SA; P < 0.0001), on postoperative day 1 (1.5 ± 1.6 for CFNC vs. 3 ± 1.7 for SA; P < 0.0001) and postoperative day 2 (1.2 ± 1.5 for CFNC vs. 2.6 ± 2.1 for SA; P < 0.0001). CFNC group consumed 39% less morphine equivalents on postoperative day 1 (4.4 ± 5.8 mg for CFNC vs. 7.2 ± 10.8 mg for SA; P = 0.005) and 50% less morphine equivalent on postoperative day 2 (3.4 ± 4.4 mg for CFNC vs. 6.8 ± 13 mg for SA; P = 0.105). Patients with CFNC had a lower rate of opioid-related side effects compared with patients with SA (27.5% for CFNC vs. 47% for SA; P = 0.001). More patients with CFNC were discharged to home with or without health services than patients with SA (15% for CFNC vs. 6% for SA; P = 0.023). Conclusion: Continuous femoral nerve catheter decreased daily average patient-reported pain scores, narcotic consumption while decreasing the rate of opioid-related side effects. Patients with CFNC were discharged to home more frequently. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.