Peripheral nerve blocks for hip fracture patients with time to surgery
GREATER THAN 24 HOURS – A RETROSPECTIVE AUDIT
Authors List Caleb Fung and Min Yee Seow, North Shore Hospital (NSH), Auckland, New Zealand
Introduction: Peripheral nerve blocks (NBs) are a safe intervention that reduce pain and opioid consumption in hip fracture (NOF) patients. Most NOF patients at NSH receive a fascia iliaca block (FIB) upon arrival in ED. Although standard of care is for patients to have surgery within 24hr of arrival, some patients wait beyond this (by which time the initial NB has worn-off). These patients therefore often require a repeat NB pre-surgery.
Aims: This audit investigated the number of patients receiving a repeat NB after waiting >24hrs for surgery; the reasons for patients not receiving a repeat NB; and whether there were associations between repeat NBs and pre-op opioid use (total pre-op opioid consumption/24hrs), post-op opioid use (number of patients discharged on opiates and/or prescribed opioids at least 2 months post-op), and post-op delirium.
Methods: Australian & New Zealand Hip Fracture Registry data and clinical notes of all hip fracture patients, admitted to NSH between January and June 2020 who waited >24hr for surgery, were assessed for NB details and clinical outcomes. Means, standard deviations, T-test and Chi-squared test were calculated.
Results: 66 patients waited >24hrs for surgery (33.7% of all 196 NOF patients), with their mean waiting time being 31hrs 53min. 57 (86.4%) received a FIB in ED. 21 (31.8%) received a repeat NB pre-surgery, and they waited 20hr 43min on average to receive this. 26 (39.4%) had a repeat NB requested, with the Orthogeriatrician making the majority of requests (69.2%). The most common reason for not receiving a repeat NB was lack of request. No statistically significant associations were found between repeat NBs and pre-op opioid use, post-op opioid use or post-op delirium.
Conclusion: This study hopes to drive local quality improvement initiatives and guide future research to ensure hip fracture patients receive adequate analgaesia and optimal peri-operative care.
References: 1. Guay J, Parker MJ, Griffiths R, Kopp S. Peripheral nerve blocks for hip fractures. Cochrane Database of Systematic Reviews. 2017(5). 2. Amin NH, West JA, Farmer T, Basmajian HG. Nerve blocks in the geriatric patient with hip fracture: a review of the current literature and relevant neuroanatomy. Geriatric orthopaedic surgery & rehabilitation. 2017 Dec;8(4):268-75.
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