Objectives: To compared outcomes of regional nerve blocks with those of standard analgesics after hip fracture. Design: Multisite randomized controlled trial from April 2009 to March 2013. Setting: Three New York hospitals. Participants: Individuals with hip fracture (N = 161). Intervention: Participants were randomized to receive an ultrasound-guided, single-injection, femoral nerve block administered by emergency physicians at emergency department (ED) admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours (n = 79) or conventional analgesics (n = 82). Measurements: Pain (0–10 scale), distance walked on Postoperative Day (POD) 3, walking ability 6 weeks after discharge, opioid side effects. Results: Pain scores 2 hours after ED presentation favored the intervention group over controls (3.5 vs 5.3, P =.002). Pain scores on POD 3 were significantly better for the intervention than the control group for pain at rest (2.9 vs 3.8, P =.005), with transfers out of bed (4.7 vs 5.9, P =.005), and with walking (4.1 vs 4.8, P =.002). Intervention participants walked significantly further than controls in 2 minutes on POD 3 (170.6 feet, 95% confidence interval (CI) = 109.3–232 vs 100.0 feet, 95% CI = 65.1–134.9; P =.04). At 6 weeks, intervention participants reported better walking and stair climbing ability (mean Functional Independence Measure locomotion score of 10.3 (95% CI = 9.6–11.0) vs 9.1 (95% CI = 8.2–10.0), P =.04). Intervention participants were significantly less likely to report opioid side effects (3% vs 12.4%, P =.03) and required 33% to 40% fewer parenteral morphine sulfate equivalents. Conclusion: Femoral nerve blocks performed by emergency physicians followed by continuous fascia iliaca blocks placed by anesthesiologists are feasible and result in superior outcomes.
- functional recovery
- hip fracture