BACKGROUND: Hip fractures frequently cause severe pain and functional decline in adults presenting to emergency departments (EDs). Although intravenous (IV) opioids are widely used for pain control, their use may be limited by adverse effects, especially in patients with comorbidities or cognitive impairment. Ultrasound-guided femoral nerve block (FNB) offers a regional analgesic technique that may provide effective pain relief while reducing opioid-related complications. However, comparative randomized trials in the ED setting remain limited.
METHODS: In this single-center, randomized, double-blind clinical trial, adult patients with radiologically confirmed hip fractures were assigned to receive either ultrasound-guided FNB (20 mL 0.5 % bupivacaine) or IV fentanyl (1 µg/kg). To preserve blinding, patients in each group received a placebo injection mimicking the alternative treatment. Pain severity was measured at baseline and 20 min post-intervention using the Numeric Pain Rating Scale or the Pain Assessment in Advanced Dementia Scale (PAINAD), based on cognitive status. The primary outcome was change in pain score at 20 min. Secondary outcomes included rescue analgesia requirement within four hours and adverse events.
RESULTS: A total of 104 patients were enrolled and randomized. The FNB group experienced greater median pain reduction compared to the fentanyl group (4 [IQR 3-5] vs. 2 [IQR 2-3]; median difference: 2, 95 % CI: 1-2). Rescue analgesia was required in 21.1 % of FNB patients versus 61.5 % in the fentanyl group. Adverse events were observed only in the fentanyl group, including nausea (23 %), dizziness (15 %), headache (9.6 %), and hypotension (5.7 %). No FNB-related complications were reported. Subgroup analysis showed consistent efficacy among cognitively impaired patients.
CONCLUSION: FNB resulted in superior analgesia, fewer side effects, and lower need for rescue opioids compared to IV fentanyl. Additionally, FNB has shown an effective and safe pain control in patients with cognitive impairment compared to patients without cognitive impairment.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06862154.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The option to provide regional block to reduce pain and need for opioid analgesics associated with acute hip fracture should always be considered. It provides effective analgesia and improves perioperative care.
Physician rater
The argument and results are known by anesthesiologists. The article does not add knowledge.
, McMaster University