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Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report

OBJECTIVES: Outcomes after traumatic hip fracture have shown to be significantly improved with timely surgical management. This study determined whether there were differences in efficacy of fascia iliaca compartment block (FICB) on pain outcomes in patients with hip fracture, once stratified by tim...

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Autores principales: Akinola, Kerrick, Salottolo, Kristin, Meinig, Richard, Fine, Landon, Madayag, Robert M, Ekengren, Francie, Tanner, Allen, Bar-Or, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9667993/
https://www.ncbi.nlm.nih.gov/pubmed/36407296
http://dx.doi.org/10.1136/tsaco-2022-000970
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author Akinola, Kerrick
Salottolo, Kristin
Meinig, Richard
Fine, Landon
Madayag, Robert M
Ekengren, Francie
Tanner, Allen
Bar-Or, David
author_facet Akinola, Kerrick
Salottolo, Kristin
Meinig, Richard
Fine, Landon
Madayag, Robert M
Ekengren, Francie
Tanner, Allen
Bar-Or, David
author_sort Akinola, Kerrick
collection PubMed
description OBJECTIVES: Outcomes after traumatic hip fracture have shown to be significantly improved with timely surgical management. This study determined whether there were differences in efficacy of fascia iliaca compartment block (FICB) on pain outcomes in patients with hip fracture, once stratified by time to surgery. METHODS: Trauma patients (55–90 years) admitted to five Level I/II trauma centers within 12 hours of hip fracture were included. Patients with coagulopathy, significant multi-trauma (injury severity score >16), bilateral hip fractures, and postoperative FICBs were excluded. The primary exposure was analgesia modality: adjunctive FICB or systemic analgesics (no FICB). Study endpoints were incidence of delirium through 48 hours postoperatively (%), preoperative and postoperative oral morphine equivalents (OMEs), and preoperative and postoperative pain (0–10 scale). Adjusted regression models were used to examine the effect of FICB on outcomes; all models were stratified by time from arrival to surgery, ≤24 hours (earlier surgery; n=413) and >24 hours (later surgery; n=143). RESULTS: FICB use was similar with earlier and later surgery (70.2% vs 76.2%), and there were no demographic differences by utilization of FICB, by time to surgery. In the earlier surgery group, preoperative pain was lower for patients with FICB versus no FICB (3.6 vs 4.5, p<0.001), with no difference by FICB for delirium (OR 1.00, p>0.99) or OMEs (p=0.75 preoperative, p=0.91 postoperative). In the later surgery group, there was a nearly twofold reduction in preoperative OMEs with FICB than no FICB (25.5 mg vs 45.2 mg, p=0.04), with no differences for delirium (OR 4.21, p=0.18), pain scores (p=0.25 preoperative, p=0.27 postoperative), and postoperative OMEs (p=0.34). CONCLUSIONS: Compared with systemic analgesia, FICB resulted in improved pain scores at the preoperative assessment among patients with earlier surgery, whereas FICB reduced opioid consumption over the preoperative period only when surgery was later than 24 hours from arrival. LEVEL OF EVIDENCE: II, prospective, therapeutic.
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spelling pubmed-96679932022-11-17 Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report Akinola, Kerrick Salottolo, Kristin Meinig, Richard Fine, Landon Madayag, Robert M Ekengren, Francie Tanner, Allen Bar-Or, David Trauma Surg Acute Care Open Brief Report OBJECTIVES: Outcomes after traumatic hip fracture have shown to be significantly improved with timely surgical management. This study determined whether there were differences in efficacy of fascia iliaca compartment block (FICB) on pain outcomes in patients with hip fracture, once stratified by time to surgery. METHODS: Trauma patients (55–90 years) admitted to five Level I/II trauma centers within 12 hours of hip fracture were included. Patients with coagulopathy, significant multi-trauma (injury severity score >16), bilateral hip fractures, and postoperative FICBs were excluded. The primary exposure was analgesia modality: adjunctive FICB or systemic analgesics (no FICB). Study endpoints were incidence of delirium through 48 hours postoperatively (%), preoperative and postoperative oral morphine equivalents (OMEs), and preoperative and postoperative pain (0–10 scale). Adjusted regression models were used to examine the effect of FICB on outcomes; all models were stratified by time from arrival to surgery, ≤24 hours (earlier surgery; n=413) and >24 hours (later surgery; n=143). RESULTS: FICB use was similar with earlier and later surgery (70.2% vs 76.2%), and there were no demographic differences by utilization of FICB, by time to surgery. In the earlier surgery group, preoperative pain was lower for patients with FICB versus no FICB (3.6 vs 4.5, p<0.001), with no difference by FICB for delirium (OR 1.00, p>0.99) or OMEs (p=0.75 preoperative, p=0.91 postoperative). In the later surgery group, there was a nearly twofold reduction in preoperative OMEs with FICB than no FICB (25.5 mg vs 45.2 mg, p=0.04), with no differences for delirium (OR 4.21, p=0.18), pain scores (p=0.25 preoperative, p=0.27 postoperative), and postoperative OMEs (p=0.34). CONCLUSIONS: Compared with systemic analgesia, FICB resulted in improved pain scores at the preoperative assessment among patients with earlier surgery, whereas FICB reduced opioid consumption over the preoperative period only when surgery was later than 24 hours from arrival. LEVEL OF EVIDENCE: II, prospective, therapeutic. BMJ Publishing Group 2022-11-15 /pmc/articles/PMC9667993/ /pubmed/36407296 http://dx.doi.org/10.1136/tsaco-2022-000970 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Brief Report
Akinola, Kerrick
Salottolo, Kristin
Meinig, Richard
Fine, Landon
Madayag, Robert M
Ekengren, Francie
Tanner, Allen
Bar-Or, David
Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report
title Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report
title_full Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report
title_fullStr Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report
title_full_unstemmed Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report
title_short Does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? A brief report
title_sort does time to surgery for traumatic hip fracture impact the efficacy of fascia iliaca blocks? a brief report
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9667993/
https://www.ncbi.nlm.nih.gov/pubmed/36407296
http://dx.doi.org/10.1136/tsaco-2022-000970
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