A Comparison in Outcomes of Preoperative Single-shot versus Continuous Catheter Fascia Iliaca Regional Anesthesia in Geriatric Hip Fracture Patients. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Stephan, Stephen R.; Garlich, John M.; Debbi, Eytan M.; Johnson, Christopher R.; Polakof, Landon S.; Noorzad, Ali S.; Moak, Zachary B.; Yalamanchili, Dheeraj R.; Stephenson, Samuel K.; Anand, Kapil K.; Lin, Carol A.; Little, Milton T.M.; Moon, Charles N.
• Is Part Of: Injury. Volume 51:Issue 6(2020)
• Page Start: 1337
• Page End: 1342
• Publication Date: 2020-06
• Subjects: Hip fracture -- Geriatric -- Opioid use -- Pain -- Regional anesthesia -- Fascia iliaca regional anesthesia; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.04.024
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: We report similar opioid use and pain scores in hip fracture patients receiving single-shot and continuous catheter blocks. Opioid related adverse events, length of stay, and readmission rates were similar between both types of block. More research is necessary to determine cost and clinical effectiveness between the types of regional anesthesia. Abstract: Background: Fascia iliaca nerve blocks relieve pain in geriatric hip fracture patients and can be administered via a single-shot or continuous catheter. We compared perioperative opioid consumption and pain scores between these two blocks. Methods: We performed a prospective, observational cohort study, including geriatric hip fracture patients who received a preoperative block. We compared morphine milligram equivalent (MME) consumption and visual analog scale (VAS) pain scores between single-shot and continuous fascia iliaca blocks at multiple time points: preoperative and on postoperative (POD) day 0, 1, and 2. We compared the change in preoperative total and hourly opioid consumption before and after block placement within and between groups. Secondary outcomes included opioid related adverse events, length of stay, and readmission rates. Results: 107 patients were analyzed, 66 received a single-shot and 41 a continuous block. No significant differences were found between both blocks at any time point for median MME consumption or pain scores. MME [IQR]: preoperative 20.5 [6.0, 48.8] vs. 24.0 [8.8, 48.0], p=0.95; POD0 6.0 [0.0, 18.6] vs. 10.0 [0.0, 14.0], p=0.52; POD1 12.0 [0.0, 30.0] vs. 18.0 [5.0, 24.0], p=0.69; POD2 6.0 [0.0, 21.2] vs. 12.0 [0.0, 24.0], p=0.54. VAS [IQR]: preoperative 4.0 [2.2, 5.3] vs. 4.6 [3.2, 5.3], p=0.34; POD0 1.3 [0.0, 3.7] vs. 2.5 [0.0, 3.6], p=0.73; POD1 2.9 [1.7, 4.4] vs. 3.7 [1.5, 4.7], p=0.59; POD2 2.4 [1.0, 4.4] vs. 3.3 [1.9, 4.2], p=0.18. Preoperative MME/hr significantly decreased after the block for both groups: 1.05 [0.0, 2.2] to 0.0 [0.0, 0.0], p < 0.001; 1.4 [0.6, 3.1] to 0.0 [0.0, 0.1], p < 0.001. The reduction in MME/hr between groups was not significantly different: 0.9 [0.0, 1.9] vs. 1.4 [0.6, 3.1], p = 0.067. We found no significant differences in secondary outcomes between groups. Conclusions: We report no differences in opioid use and pain scores between single-shot and continuous catheter fascia iliaca nerve blocks. Both blocks similarly reduce preoperative opioid consumption.