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Time to Block: Early Regional Anesthesia Improves Pain Control in Geriatric Hip Fractures
John M Garlich1, Amit Pujari1, Eytan M Debbi1
1Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California.
The Journal of Bone and Joint Surgery. American Volume
|March 21, 2020
Summary
Faster fascia iliaca nerve blocks (FIBs) for hip fracture patients reduce opioid use and pain. Prompt administration of FIBs is linked to shorter hospital stays and better outcomes for geriatric patients.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Orthopedic Surgery
Background:
- Fascia iliaca nerve blocks (FIBs) are recommended for preoperative pain management in geriatric hip fracture patients.
- Delays in administering FIBs can lead to increased pain and worse patient outcomes.
- This study investigates the impact of time to block (TTB) on patient outcomes.
Purpose of the Study:
- To determine if time to block (TTB) affects opioid consumption and pain levels in geriatric hip fracture patients.
- To examine the relationship between TTB and length of hospital stay.
- To assess the impact of TTB on opioid-related adverse events.
Main Methods:
- A prospective cohort study of 107 geriatric patients (≥60 years) with hip fractures receiving preoperative FIBs.
- Analysis of individualized care timelines to evaluate TTB and time to surgery (TTS) effects.
- Spearman rho correlation and multivariable regression were used to analyze TTB, TTS, and morphine milligram equivalents (MME).
Main Results:
- A median TTB of 8.5 hours was observed, with 72% of opioid consumption occurring before block placement.
- Longer TTB correlated strongly with higher preoperative opioid consumption (MME).
- Faster TTB was associated with reduced preoperative opioid use, lower postoperative pain scores, and shorter hospital stays.
Conclusions:
- Expedited administration of fascia iliaca nerve blocks (FIBs) can significantly decrease opioid consumption and pain in geriatric hip fracture patients.
- Reducing the time to block (TTB) may lead to shorter hospital lengths of stay.
- Optimizing FIBs timing is crucial for improving perioperative pain management and patient outcomes.
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