Opioid use before hip fracture surgery may be reduced with early ultrasound-guided femoral nerve block

When compared to usual treatment, patients who were randomly assigned to undergo an early ultrasound-guided femoral nerve block (FNB) for hip fractures and severe pain showed less opioid use before to surgery without experiencing a delay in reaching optimum pain management.

Elderly individuals often suffer from excruciating injuries like hip fractures. Forty percent of patients may obtain subpar pain treatment, and 50 to 70 percent of patients have severe pain. Even while the first line of treatment for pain is often opioids, the frequency of negative consequences linked to opioid usage emphasises the need to investigate other options. A recently published randomised study attempts to evaluate the effect on preoperative painkiller intake of early ultrasound-guided FNB, started at diagnosis. Patients with a hip fracture confirmed by radiography and a pain score of ≥ 7 (on a verbal numerical scale from 0 to 10 points) at emergency department triage were identified and randomised 1:1 to receive ultrasound-guided FNB (n = 15) or standard care (n = 15) between September and December 2022. Ultrasound-guided forced ambulation with morphine decreased preoperative opioid consumption by 60% compared to the conventional group, resulting in a reduction of 9 morphine milligramme intravenous equivalents (MME) (95% CI: 3–14, P < 0.001). The average time for ultrasound-guided FNB was 13.6 ± 6.5 minutes, and the amount of time it took for each group to have pain alleviation was not statistically different. The ultrasound-guided FNB group had a 56% decrease in opiate intake throughout the hospital stay, with a difference of 11.5 MME (95% CI: 0.5–22). In the ultrasound-guided FNB group, opioid adverse events were 40% lower (95% CI: 5.1–74.9) and there were no observed FNB-related adverse effects. Overall, these results support the use of early single ultrasound-guided FNB by qualified emergency physicians as an alternative to intravenous opioids in older patients with hip fractures, as it reduces preoperative opioid consumption without delaying the time to pain relief.

Reference –

Gerlier, Camillea; Mijahed, Ramia; Fels, Audreyb; Bekka, Samirc; Courseau, Romaind; Singh, Anne-Lysea; Ganansia, Oliviera; Chatellier, Gillese. Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomized trial. European Journal of Emergency Medicine 31(1):p 18-28, February 2024. | DOI: 10.1097/MEJ.0000000000001075.