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Fascia iliac blocks may reduce opioid use in patients with hip fractures

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Spencer Schulte

DENVER — In patients with hip fractures, adjuvant fascia iliac blocks may decrease postoperative narcotic consumption and increase mobilization, according to a presenter at the Orthopaedic Trauma Association Annual Meeting.

“For patients with hip fractures, the fascia iliac block as a part of multimodal pain management may contribute to lesser opioid use and greater ambulation,” Spencer Schulte, MD, said during his presentation.

At a level 1 trauma center, Schulte and colleagues identified 85 patients with femoral neck fractures, intertrochanteric fractures or subtrochanteric hip fractures. Based on the medical record number, 48 patients were randomized to receive a fascia iliac block and the remaining patients did not receive a block. The morphine-equivalent dose of opiate consumption, VAS scores, postsurgical 72-hour ambulatory distance, block-associated complications and length of stay were among the primary outcomes. Other outcomes included postoperative complications and discharge disposition.

Results showed no difference between the groups with regard to demographics, fracture type and disposition at discharge. No difference was seen between the groups with regard to VAS scores. However, decreased opiate use was seen in patients who received the fascia iliac block compared with patients who did not (morphine-equivalent dose 62.3 vs. 107.5). Greater postoperative day 3 walking distance and 72-hour cumulative walking distance were seen in patients who received a block. Patients who received a block had a decreased length of stay compared with those who did not receive a block (5 vs. 6 days).

“We had 12 patients who crossed over to the block from the control group,” he said. “Likewise, [there were] 15 patients who crossed over to the control group. Those patients who crossed over to the block group were younger, they [were] more likely to have a higher rate of pain, as well as consumed more morphine equivalents and walked a shorter distance.” – by Monica Jaramillo

Reference:

Schulte S, et al. Abstract 71. Presented at: Orthopedic Trauma Association Annual Meeting; Sept. 25-28, 2019; Denver.

Disclosure: Schulte reports no relevant financial disclosures.