Continuous Fascia Iliaca Compartment Block Improves Outcomes in Hip Fragility Fracture Patients

Objectives The objective of this study was to evaluate the safety of continuous fascia iliaca compartment block (CFICB) and its efficacy in reducing postoperative pain, opioid use, and postoperative delirium in patients undergoing surgical repair of hip fragility fractures (HFF), compared with those who did not receive regional anesthesia (RA). Secondary outcomes included differences in hospital and post-anesthesia care unit (PACU) length of stay (LOS), discharge destination, hospital readmissions, and postoperative complications. Methods This was a retrospective cohort study conducted at a specialized bone and joint hospital. The study included patients aged ≥65 years who underwent surgical repair of HFF within 48 hours of injury following admission from the emergency department between July 2018 and August 2020. The intervention consisted of CFICB administered for HFF repair surgery. The main outcomes measured were postoperative pain scores, opioid consumption in morphine milliequivalents, and the incidence of postoperative delirium. Results  A total of 209 patients who underwent surgical repair of HFF were included, with 96 patients receiving CFICB and 113 patients receiving no RA (control). Average pain scores at rest and during activity, maximum pain scores at rest, and postoperative and total opioid use were significantly lower in the CFICB group compared with controls (P < 0.05). PACU LOS was longer in the CFICB group (P < 0.05), while other secondary outcomes showed no significant differences between groups. Baseline dementia was a predictor of postoperative delirium; however, the overall incidence of postoperative delirium was similar between groups. Conclusions CFICB is a safe RA technique for elderly patients undergoing HFF surgical repair. This study is the first to demonstrate CFICB efficacy in reducing pain and opioid use in this specific population. Despite these benefits, CFICB did not significantly reduce the incidence of postoperative delirium. Further research is needed to optimize anesthetic regimens and improve additional outcomes in elderly HFF patients.