Pain Management in Geriatric Hip Fracture Patients with Ultrasound-Guided Continuous Fascia Iliaca Compartment Block: a Pilot Study

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Chayapa Luckanachanthachote
Pawinee Pangthipampai
Pawinee Pangthipampai
Arissara Iamaroon
Choopong Luansritisakul
Piyawadee Rungmongkolsab
Suwimon Tangwiwat

Abstract

Background: Hip fracture is a painful urgency condition in elderly patients. Femoral nerve block, fascia iliaca compartment block (FICB) and lumbar plexus block have shown the benefits in geriatric hip fracture by reducing pain on movement at 30 minutes. Objectives: To determine an effectiveness of preoperative continuous FICB on static and dynamic pain relief after placement. Secondary objectives include morphine consumption, safety of continuous FICB, opioids-related side effects, ambulatory achievement and incidence of in-hospital and 6-weeks morbidities and mortality. Methods: A prospective observational study included 19 geriatric patients scheduled for hip surgery. An anesthesiologist, experienced on ultrasound-guided nerve blocks, performed ultrasound-guided supra-inguinal continuous FICB technique on within 24 hours hospital admission with 20 ml of 0.25% levobupivacaine in patients reported pain numerical rating scale (NRS ≥ 4). NRS at rest and on movement were compared between pre-block and post-block until postoperative day 2, using Wilcoxon signed rank test. Secondary outcome was reported as descriptive data. Results: A total of 19 patients had markedly dynamic pain relief from median pain score of 10 (IQR 8-10) on pre-block to 3 (IQR 0-5), P<0.001 at 30-minute post-block and continued to provide an effective pain relief until 48 hour (P=0.012) after blockade. We did not observe any major catheter-related problems. Incidence of morbidities and mortality were not different from other trials. Conclusion: Early continuous FICB placement has shown as a safe and effective pain management. It can provide titratable analgesia and prolonged analgesic duration. Continuous FICB may be indicated for elderly patients with acute hip fracture underwent operative delay.

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References

Loggers SAI, Van Lieshout EMM, Joosse P, Verhofstad MHJ, Willems HC. Prognosis of nonoperative treatment in elderly patients with a hip fracture: a systematic review and meta-analysis. Injury. 2020;51:2407-13.

Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth. 2008;55:146-54.

Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7:e46175.

Danford NC, Logue TC, Boddapati V, Anderson MJJ, Anderson FL, Rosenwasser MP. Debate update: surgery after 48 hours of admission for geriatric hip fracture patients is associated with increase in mortality and complication rate: a study of 27,058 patients using the national trauma data bank. J Orthop Trauma. 2021;35:535-41.

Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop. 2003;27:11-7.

Arshi A, Lai WC, Chen JB, Bukata SV, Stavrakis AI, Zeegen EN. Predictors and sequelae of postoperative delirium in geriatric hip fracture patients. Geriatr Orthop Surg Rehabil. 2018;9:2151459318814823.

Heiden JJ, Goodin SR, Mormino MA, et al. Early ambulation after hip fracture surgery is associated with decreased 30-day mortality. J Am Acad Orthop Surg. 2021;29:e238-e42.

Roberts KC, Brox WT. AAOS Clinical practice guideline: Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23:138-40.

Ftouh S, Morga A, Swift C, Guideline development G. Management of hip fracture in adults: summary of NICE guidance. BMJ. 2011;342:d3304.

Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care. 2011;39:545-58.

Guay J, Kopp S. Peripheral nerve blocks for hip fractures in adults. Cochrane Database Syst Rev. 2020;11:CD001159.

Birnbaum K, Prescher A, Hessler S, Heller KD. The sensory innervation of the hip joint-an anatomical study. Surg Radiol Anat. 1997;19:371-5.

Ma Y, Wu J, Xue J, Lan F, Wang T. Ultrasound-guided continuous fascia iliaca compartment block for pre-operative pain control in very elderly patients with hip fracture: a randomized controlled trial. Exp Ther Med. 2018;16:1944-52.

Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011;66:300-5.

Macintyre PE, Schug SA. Acute pain management: a practical guide. 5th ed. Boca Raton: CRC Press; 2021. p 37.

Mangram AJ, Oguntodu OF, Hollingworth AK, et al. Geriatric trauma G-60 falls with hip fractures: a pilot study of acute pain management using femoral nerve fascia iliac blocks. J Trauma Acute Care Surg. 2015;79:1067-72.

Stephan SR, Garlich JM, Debbi EM, et al. A comparison in outcomes of preoperative single-shot versus continuous catheter fascia iliaca regional anesthesia in geriatric hip fracture patients. Injury. 2020;51:1337-42.

Wennberg P, Moller M, Sarenmalm EK, Herlitz J. Evaluation of the intensity and management of pain before arrival in hospital among patients with suspected hip fractures. Int Emerg Nurs. 2020;49:100825.

Steenberg J, Moller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018;120:1368-80.

Pincus D, Wasserstein D, Ravi B, et al. Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada. CMAJ. 2018;190:E702-9.

Chen L, Shen Y, Liu S, Cao Y, Zhu Z. Ultrasound-guided supra-inguinal fascia Iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial. BMC Geriatr. 2021;21:669.

Nie H, Yang YX, Wang Y, Liu Y, Zhao B, Luan B. Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture. Pain Res Manag. 2015;20:210-2.

Foss NB, Kristensen BB, Bundgaard M, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology. 2007;106:773-8.

Wennberg P, Norlin R, Herlitz J, Sarenmalm EK, Moller M. Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial. Int J Orthop Trauma Nurs. 2019;33:35-43.

Thompson J, Long M, Rogers E, et al. Fascia iliaca block decreases hip fracture postoperative opioid consumption: a prospective randomized controlled trial. J Orthop Trauma. 2020;34:49-54.

Rasappan K, Chua ITH, Tey JBL, Ho SWL. The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients. Arch Orthop Trauma Surg. 2021;141:29-37.

Leung JM, Sands LP, Lim E, Tsai TL, Kinjo S. Does preoperative risk for delirium moderate the effects of postoperative pain and opiate use on postoperative delirium? Am J Geriatr Psychiatry. 2013;21:946-56.

Bomberg H, Kubulus C, List F, et al. Diabetes: a risk factor for catheter-associated infections. Reg Anesth Pain Med. 2015;40:16-21.

Bomberg H, Albert N, Schmitt K, et al. Obesity in regional anesthesia-a risk factor for peripheral catheter-related infections. Acta Anaesthesiol Scand. 2015;59:1038-48.

Marhofer D, Marhofer P, Triffterer L, Leonhardt M, Weber M, Zeitlinger M. Dislocation rates of perineural catheters: a volunteer study. Br J Anaesth. 2013;111:800-6.

Verbeek T, Adhikary S, Urman R, Liu H. The application of fascia iliaca compartment block for acute pain control of hip fracture and surgery. Curr Pain Headache Rep. 2021;25:22.

Chen L, Wu Y, Cai Y, et al. Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient-controlled analgesia with thoracic paravertebral block catheter: a randomized, double-blind,

controlled trial. Reg Anesth Pain Med. 2019;44:240-5.

Hashimoto A, Ito H, Sato Y, Fujiwara Y. Automated intermittent bolus infusion for continuous sciatic nerve block: a case report. Masui. 2011;60:873-5.

Fibla JJ, Molins L, Mier JM, Hernandez J, Sierra A. A randomized prospective study of analgesic quality after thoracotomy: paravertebral block with bolus versus continuous infusion with an elastomeric pump. Eur J Cardiothorac Surg. 2015;47:631-5.

Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg. 2010;111:1552-4.

American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674-94.

Muangpaisan W, Assantachai P, Sitthichai K, Richardson K, Brayne C. The distribution of Thai Mental State Examination scores among non-demented elderly in suburban Bangkok Metropolitan and associated factors. J Med Assoc Thai. 2015;98:916-24.