Background

Geriatric hip fractures are common injuries that are associated with high morbidity and mortality. Adequate pain control remains a challenge as the altered physiology in elderly patients makes use of traditional analgesics challenging. The use of regional anesthetics, specifically the fascia iliaca compartment block (FICB), in the perioperative period has been shown to decrease opioid use in this population. This study aimed to investigate the effect the FICB had on pain control, length of stay, readmissions, and complications in a 30-day postoperative period.

Methods

This was a retrospective cohort study comparing patients who sustained hip fractures; one cohort (110 patients) received a preoperative fascia iliaca block with continuous infusion (FICB), whereas the other cohort (110 patients) did not receive a block (NO-FICB). Both cohorts were from level II trauma centers. Data were collected between 2016 and 2019. Descriptive statistics was performed to describe and summarize the data. Bivariate analysis was performed using chi-square test, with 2 tailed P-values ≤ .05 were considered statistically significant.

Results

The FICB group had a lower length of stay (3.9 days vs 4.8 days; P < .001), and lower pain scores on post-operative days 2 and 3 (P = .019). There was no difference in time from admission to surgery (P = .112) or narcotic use between cohorts (P = .304). However, the FICB group was more likely to discharge to a skilled nursing facility (P=.002), and more likely to be readmitted within 30 days (P = .047). There were no differences in medical complications or mortality between the 2 groups.

Conclusions

The primary study endpoint, length of stay, was found to be significantly shorter in the patients who underwent the FICB vs the group who did not undergo the FICB. Pain scores on POD2 and POD3 were lower in patients who received a FICB. This study adds to the body of evidence that the FICB is an effective addition to a multimodal pain pathway.

Level of Evidence

Level III Evidence – Retrospective Cohort Study

中文翻译：

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髂筋膜阻滞对髋部骨折围手术期疼痛控制的影响：回顾性回顾

 背景

老年髋部骨折是常见损伤，发病率和死亡率较高。充分的疼痛控制仍然是一个挑战，因为老年患者生理机能的改变使得传统镇痛药的使用变得困难。围手术期使用区域麻醉剂，特别是髂筋膜室阻滞 (FICB) 已被证明可以减少该人群的阿片类药物使用。本研究旨在调查 FICB 对术后 30 天的疼痛控制、住院时间、再入院和并发症的影响。

 方法

这是一项回顾性队列研究，比较了髋部骨折的患者。一组（110 名患者）接受术前髂筋膜阻滞并持续输注（FICB），而另一组（110 名患者）未接受阻滞（NO-FICB）。两个队列都来自二级创伤中心。数据收集于2016年至2019年之间。进行描述性统计以描述和总结数据。使用卡方检验进行双变量分析，2尾P值≤0.05被认为具有统计显着性。

 结果

FICB 组的住院时间较短（3.9 天 vs 4.8 天； P < .001），并且术后第 2 天和第 3 天的疼痛评分较低（ P = .019）。队列之间从入院到手术 ( P = .112) 或麻醉剂使用的时间没有差异 ( P = .304)。然而，FICB 组更有可能出院到专业护理机构 (P=.002)，并且更有可能在 30 天内重新入院 ( P =.047)。两组之间的医疗并发症或死亡率没有差异。

 结论

研究发现，与未接受 FICB 的患者相比，接受 FICB 的患者的主要研究终点（即住院时间）显着缩短。接受 FICB 的患者 POD2 和 POD3 疼痛评分较低。这项研究进一步证明 FICB 是多模式疼痛通路的有效补充。

 证据水平

III 级证据——回顾性队列研究