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Review
. 2017 Dec;8(4):268-275.
doi: 10.1177/2151458517734046. Epub 2017 Oct 13.

Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy

Nirav H Amin  1 , Jacob A West  2 , Travis Farmer  1 , Hrayr G Basmajian  3
Affiliations
Review

Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy

Nirav H Amin et al. Geriatr Orthop Surg Rehabil. 2017 Dec.

Abstract

Introduction: Hip fracture is a common occurrence in the elderly population with high morbidity and mortality due to postoperative pain and opioid use. The goal of this article is to review the current literature on the neuroanatomy of the hip and the use of localized nerve block in controlling hip fracture pain.

Methods: A thorough search of MEDLINE/PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted using the search terms "hip fracture" and "fascia iliaca block (FICB)." An additional search was conducted utilizing multiple search terms including "hip fracture," "greater trochanter," "femur," "hip," "anatomy," "neuroanatomical," and "anatomic." Each search result was investigated for cadaveric studies on the innervation of the trochanteric region.

Results: Twenty-five clinical studies examining the use of FICBs in hip fracture patients were identified. These studies show that FICB is safe and effective in controlling perioperative pain. Additionally, FICB has been shown to decrease opioid requirement and opioid-related side effects. Neuroanatomical studies show that the hip capsule is innervated by contributions from the femoral, obturator, sciatic, and superior gluteal nerves. Imaging studies suggest that FICB anesthetizes these branches through localized spread along the fascia iliaca plane. Cadaveric evidence suggests that the greater trochanter region is directly innervated by a single branch from the femoral nerve.

Discussion: The proven efficacy of nerve blocks and their anatomic basis is encouraging to both the anesthesiologist and orthopedic surgeon. Their routine use in the hip fracture setting may improve patient outcomes, given the unacceptably high morbidity and mortality associated with opioid use.

Conclusions: Localized nerve blocks, specifically FICB, have been shown to be safe and effective in managing acute hip fracture pain in geriatric patients, leading to decreased opioid use. Knowledge of the hip neuroanatomy may help guide future development of hip fracture pain blockade.

Keywords: fascia iliaca compartment block; hip fracture; nerve block; nerves; pain.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Anatomical diagram of the innervation of the hip.
See this image and copyright information in PMC

References

    1. Dyer S, Crotty M, Fairhall N, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16:158. - PMC - PubMed
    1. Brown C, Starr A, Nunley J. Analysis of past secular trends of hip fractures and predicted number in the future 2010-2050. J Orthop Trauma. 2012;26(2):117–122. - PubMed
    1. Currie C, Plant F, Roberts J, et al. The national hip fracture database national report. London: NHFD, British Geriatrics Society; 2012:1–115.
    1. Strike S, Sieber F, Gottschalk A, Mears SC. Role of fracture and repair type on pain and opioid use after hip fracture in the elderly. Geriatric Orthop Surg Rehabil. 2013;4(4):103–108. - PMC - PubMed
    1. Morrison R, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci.2003;58(1);76–81. - PubMed