Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery
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REGIONAL ANESTHESIA (P KUKREJA, SECTION EDITOR)
Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery Jyoti Dangle 1 & Promil Kukreja 1 & Hari Kalagara 1
# The Author(s) 2020
Abstract Purpose of Review This article aims to describe the anatomical and technical aspects of various regional techniques used for fracture hip and hip surgery. We reviewed the commonly used nerve blocks, interfascial plane blocks and current evidence of their utility in hip fracture patients. Recent Findings Fascia iliaca compartment block (FICB) and femoral nerve block (FNB) are the most commonly used nerve blocks for providing pain relief for hip fracture patients. Supra-inguinal FICB has more consistent spread to all nerves and can enable better pain control. Both the FICB and FNB have shown analgesic efficacy with reduced pain scores, opioid sparing effect, and they enable better patient positioning for spinal in the operating room. These nerve blocks in the elderly patients can also have beneficial effects on delirium, reduced hospital length of stay, and decreased incidence of pneumonia. Some of the novel interfascial plane blocks like PEricapsular Nerve Group (PENG) blocks are now being explored to provide pain relief for fracture hip. Summary Hip fracture in the elderly has associated morbidity and mortality. Early surgical intervention has shown to reduce morbidity and mortality. Pain management in this elderly population poses a unique challenge and complementing with regional anesthesia for analgesia has shown numerous benefits. Keywords Hip fracture . Peripheral nerve blocks . Regional anesthesia . Fascia iliaca block . Femoral nerve block . PENG block
Introduction The current shift toward longevity brings with it a multitude of medical issues. One such is the incidence of osteoporotic fractures, namely, hip fracture. The annual incidence of hip fractures in the USA is 280,000 with women being twice as prone as men especially in the elderly population [1]. A comparison study in postmenopausal women showed that the burden of hospital cost was the highest for hospitalizations due to osteoporotic fractures with myocardial infarction ranking in second followed by stroke and then breast cancer [2]. Studies have shown that hip fractures in elderly are associated with significant morbidity, especially the need of long-term care
and 1-year mortality of 30%. Opioids are commonly used along with other multimodal techniques to address pain. The elderly due to altered pharmacodynamics and coexisting medical conditions are vulnerable to the side effects of opioids especially opioid-related respiratory depression. Early surgery within 48 h of fracture has shown to decrease complication and mortality rates [3]. This gives an opportunity for anesthesiologists to participate in patient’s pain control early on especially in terms of offering regional analgesia for effective pain control. The nerve blocks provide superior analgesia with decreased use of opioids and various other benefits. In this current review,
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