@article{3dcf5e8eb6e14973abfeca1e92389e79,
title = "Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial",
abstract = "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.",
keywords = "functional recovery, hip fracture, pain",
author = "Morrison, {R. Sean} and Eitan Dickman and Ula Hwang and Saadia Akhtar and Taja Ferguson and Jennifer Huang and Jeng, {Christina L.} and Nelson, {Bret P.} and Rosenblatt, {Meg A.} and Silverstein, {Jeffrey H.} and Strayer, {Reuben J.} and Torrillo, {Toni M.} and Todd, {Knox H.}",
note = "Funding Information: This project was supported by Grant R01AG030141 from the National Institute on Aging. Dr. Morrison was supported by Mid-Career Investigator Award in Patient-Oriented Research AGK24AG022345 and Older Adult Independence Center Grant 5P30AG028741 from the National Institute on Aging. Dr. Hwang was supported by Mentored Patient-Oriented Research Career Development Award K23AG031218 from the National Institute on Aging. Trial Registration: ClinicalTrials.gov, Identifier: NCT00749489. Available at: https://clinicaltrials.gov/ct2/show/NCT00749489?term=hip+fracture&state1=NA%3AUS%3ANY&rank=1. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Dr. Silverstein died before the study's completion. At the time of his death, he reported no conflicts of interest. Author Contributions: Morrison, Todd: co-principle investigators, study concept and oversight, data analysis and interpretation, drafting the article, critical revision for important intellectual content, writing manuscript draft, final approval of version submitted. Dickman: study performance, data analysis and interpretation, critical revision for important intellectual content, final approval of the version submitted. Hwang, Rosenblatt: study concept and performance, data analysis and interpretation of data, critical revision for important intellectual content, final approval of version submitted. Akhtar, Huang, Jeng, Nelson, Strayer, Torrillo, Ferguson: study performance, data interpretation, critical revision for important intellectual content, final approval of version submitted. Silverstein: study concept and performance, data interpretation, critical revision for important intellectual content, final approval of version submitted. Sponsor's Role: The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Publisher Copyright: {\textcopyright} 2016, Copyright the Authors Journal compilation {\textcopyright} 2016, The American Geriatrics Society",
year = "2016",
month = dec,
day = "1",
doi = "10.1111/jgs.14386",
language = "English",
volume = "64",
pages = "2433--2439",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "12",
}