Peripheral nerve blocks for hip fractures in adults

Area of Science:

• Anesthesiology and Pain Management
• Orthopedic Surgery
• Geriatric Medicine

Background:

• Hip fractures are common, with numerous guidelines for management.
• Perioperative peripheral nerve blocks (PNBs) may improve patient outcomes.
• PNBs can potentially reduce opioid use for pain relief.

Purpose of the Study:

• To compare PNBs versus no nerve block for adults with hip fracture.
• To evaluate PNBs as preoperative, postoperative, or supplemental anesthesia.
• To assess outcomes including pain, confusion, infection, and mobilization.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases (CENTRAL, MEDLINE, Embase, CINAHL) up to November 2019.
• Included 49 RCTs (3061 participants); assessed risk of bias and used GRADE for evidence certainty.

Main Results:

• PNBs significantly reduced pain on movement within 30 minutes (high-certainty evidence).
• PNBs reduced the risk of acute confusional state (high-certainty evidence).
• PNBs likely reduce chest infection risk and time to first mobilization (moderate-certainty evidence).

Conclusions:

• PNBs are effective in reducing pain, acute confusional state, and improving mobilization in hip fracture patients.
• Evidence suggests PNBs may reduce chest infection risk and analgesic costs.
• Low risks of permanent injury associated with PNBs; further non-randomized trials may clarify effects on mortality and myocardial infarction.