Published in:
Open Access
01-12-2010 | Original Research Article
Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics
Authors:
Daniel Godoy Monzón, Jorge Vazquez, José R. Jauregui, Kenneth V. Iserson
Published in:
International Journal of Emergency Medicine
|
Issue 4/2010
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Abstract
Background
This prospective, randomized double-blind study, conducted over 19 months in a tertiary care ED, sought to determine if a fascia-iliaca regional anesthetic block provides better and safer pain relief than does parenteral analgesia.
Aims
This study also aimed to determine the effectiveness of parenteral NSAID analgesia for acute hip fractures.
Methods
Patients >65 years old presenting at an adult ED with acute hip fractures were randomized upon presentation to the ED into two groups (A and B) using numbers generated by the EPI-INFO™ (Atlanta, GA: Centers for Disease Control and Prevention) program. The randomization list was kept by one of the authors who did not interact with the patients. Two groups of patients were to receive either (A) a fascia-iliaca block with bupivacaine and parenteral saline injection, or (B) the same block with saline and an IV NSAID injection. Upon admission to the study, vital signs such as blood pressure, mean blood pressure (MAP), heart rate (HR), respiratory rate (RR) and pain-intensity measurements [using the Visual Analogue Scale (VAS)] were obtained and repeated at 15 min, 2 h and at8 h. The occurrence of complications was registered.
Results
One hundred seventy-five patients were randomized, and 21 were excluded from participation. The remaining 154 patients were grouped as: group A (n = 62) or group B (n = 92). The mean pain level on admission to the ED for all patients, assessed with the VAS, was 8.21 ± 0.91 (CI 95%: 6.43–9.99); in group A the VAS was 7.6 ± 0.22 and in group B 8.5 ± 0.72 (p = 0.411). At 15-min evaluation, values were: group A 6.24 ± 0.17 and group B 2.9 ± 0.16 (p < 0.001). At the 2-h assessment, values were: group A 1.78 ± 0.11 and group B 2.3 ± 1.16 (p = 0.764). At 8 h the VAS for group A was 2.03 ± 0.12 and for group B 4.4 ± 0.91 (p = 0.083).
Conclusion
This study demonstrates that: (1) parenteral NSAIDs are very effective as analgesics after hip fractures in elderly patients, (2) fascia-iliaca regional blocks are nearly as effective for up to about 8 h after administration and (3) regional fascia-iliaca blocks effectively control post-hip fracture pain. (4) Fascia iliaca regional block has a rapid onset.