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Randomized Controlled Trial
. 2016 Mar;34(3):586-9.
doi: 10.1016/j.ajem.2015.12.016. Epub 2015 Dec 14.

Ultrasound-guided nerve blocks for intracapsular and extracapsular hip fractures

Eitan Dickman  1 , Illya Pushkar  2 , Antonios Likourezos  1 , Knox Todd  3 , Ula Hwang  4 , Saadia Akhter  5 , Sean Morrison  4
Affiliations
Randomized Controlled Trial

Ultrasound-guided nerve blocks for intracapsular and extracapsular hip fractures

Eitan Dickman et al. Am J Emerg Med. 2016 Mar.

Abstract

Objectives: To compare pain relief between patients with intracapsular and extracapsular hip fractures who received an ultrasound-guided femoral nerve block (USFNB).

Design: A multicenter, prospective, randomized, clinical trial.

Setting: The study was conducted in the emergency departments of 3 academic hospitals located in New York City.

Subjects: Patients aged ≥60 years presenting to the emergency department with hip fracture.

Methods: A subgroup analysis from a larger data set was conducted of patients with intracapsular and extracapsular hip fractures who received an USFNB. We compared pain scores at baseline and then at 2 and 3 hours after the nerve block was performed, and also assessed pain relief at 2 and 3 hours.

Results: Seventy-seven patients were randomized to receive USFNB, of which 68 had follow-up data at 2 and 3 hours and were included in the data analysis. Thirty-one were diagnosed with intracapsular and 37 with extracapsular hip fractures. In both groups, reductions in pain scores were clinically and statistically significant. In the intracapsular group, mean pain scores decreased from 6.23 to 3.81 (P < .0001) at 2 hours and from 6.23 to 3.87 (P < .0001) at 3 hours. In the extracapsular group, mean pain scores decreased from 6.62 to 3.89 (P < .0001) at 2 hours and from 6.62 to 3.46 (P < .0001) at 3 hours. These differences were similar between the extracapsular and intracapsular groups at 2 hours (P = .92) and at 3 hours (P = .58), thus demonstrating similar reductions in pain in the 2 groups. The differences in pain relief between the intracapsular and extracapsular groups were also similar: 1.61 (confidence interval [CI], 1.14-2.08) vs 1.35 (CI, 0.96-1.75) at 2 hours (P = .39) and 1.68 (CI, 1.21-2.15) vs 1.38 (CI, 0.89-1.87) at 3 hours (P = .38).

Conclusion: Ultrasound-guided femoral nerve block was equally effective in reducing pain for patients with both intracapsular and extracapsular hip fractures.

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Figures

Figure 1
Figure 1
Pain relief numeric rating scale.
Figure 2
Figure 2
Participant flow diagram.
Figure 3
Figure 3
Patient Reported pain with 95% Confidence Interval bars.
See this image and copyright information in PMC

References

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