• Humans
• Analgesics/therapeutic use
• Analgesics/administration & dosage
• Fascia/innervation
• Femoral Fractures
• Hip Fractures/complications
• Nerve Block/methods
• Network Meta-Analysis as Topic
• Pain Management/methods
• Proximal Femoral Fractures
• Systematic Reviews as Topic

• Key Laboratory Open Fund Project of Chongqing University Cancer Hospital
• Chongqing Science and Technology Bureau joint Health Bureau

• Humans
• Hip Fractures/surgery
• Nerve Block/methods
• Pain Management/methods
• Preoperative Care/methods
• Network Meta-Analysis
• Pain Measurement
• Randomized Controlled Trials as Topic
• Femoral Nerve
• Length of Stay

• emergency department
• fascia iliaca compartment block
• femoral nerve block
• femur fracture

• Fascia iliaca compartment block
• Femoral fractures close to the hip joint
• Femoral nerve block
• Geriatric traumatology
• Proximal femoral fractures
• Regional anesthesia

• PENG block
• hip fracture
• neck of femur
• regional anaesthesia
• ultrasound

Pain management modalities after proximal femoral fracture are variable and have been studied extensively. Regional anesthesia, specifically femoral nerve (FNB) and fascia iliaca compartment blocks (FICB), can be used to provide analgesia preoperatively.

Systematic searches of all related literature were conducted in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Randomized controlled trials (RCTs) of proximal femoral fractures were included. The pain scores at different time points, opioid requirement in 24 h, mean arterial pressure, time for spinal anesthesia, patient satisfaction, and incidence of side effects between the 2 groups were extracted throughout the study.

Fifteen RCTs including 1240 patients met the inclusion criteria. The present meta-analysis indicated that compared with FNB, FICB could decrease the visual analog scale (VAS) scores at 4 h after surgery (P < .05). The incidence of side effects (nausea, vomiting, and sedation) was lower in the FNB group (P < .05). Compared to the FICB, no significant difference was found at any other observed time point. Additionally, no difference was found in opioid requirement at 24 h, mean arterial pressure, time for spinal anesthesia, or patient satisfaction (P > .05).

FICB demonstrates a reduction in VAS score at 4 while FNB decreases the risk of several adverse events. More high-quality RCTs are necessary for proper comparison of the efficacy and safety of FNB and FICB.

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.

• Orthopedic surgery
• Regional anesthesia
• Spinal
• Epidural
• Combined spinal epidural
• Peripheral nerve blocks
• Neuraxial blocks
• Upper extremity
• Lower extremity
• Interscalene
• Supraclavicular
• Infraclavicular
• Axillary
• Femoral
• Fascia iliaca
• Popliteal
• Sciatic
• Saphenous
• Adductor canal
• Lumbar plexus
• Brachial plexus
• Ankle
• iPACK
• Complication
• Local anesthetic systemic toxicity
• Nerve injury
• Block failure
• Continuous nerve block catheters

To determine whether the addition of dexmedetomidine either in peripheral block or via systemic route leads to prolongation of the duration of analgesia is inconclusive. The present study aimed to assess the duration of postoperative analgesia with dexmedetomidine used as an additive with bupivacaine for ultrasound-guided femoral nerve block (FNB) and to compare it with intramuscular dexmedetomidine along with FNB.

A prospective, double-blind randomized clinical trial involving adult patients undergoing elective hip surgery, performed under subarachnoid block. When sensory block receded to T12 after the surgery, FNB was given for postoperative analgesia. Patients were randomized into three groups; Group A received FNB with 40 mL 0.25% bupivacaine and 0.5 mL saline as IM injection, Group B received FNB with 39.5 mL of 0.25% bupivacaine + 0.5 mL (50 mcg) of dexmedetomidine in the affected limb and 0.5 mL saline IM injection, and Group C received FNB with 40 mL of 0.25% bupivacaine and 0.5 mL (50 mcg) of dexmedetomidine as IM injection. Postoperative pain was assessed and for pain with VAS score >3, intravenous tramadol was given as rescue analgesia. Chi-square test for categorical variables and one-way ANOVA for continuous variables.

The mean duration of analgesia in groups A, B, and C was 671, 676, and 490 min, respectively which was not significant. A 24 h analgesic requirement was also not different between the groups.

The use of dexmedetomidine perineurally or systemically did not prolong the duration of analgesia as compared to bupivacaine alone for femoral nerve block.

• Bupivacaine
• USG-guided femoral nerve block
• dexmedetomidine
• hip surgery
• postoperative pain

• Humans
• Femoral Neck Fractures/surgery
• Female
• Male
• Nerve Block/methods
• Aged
• Pain, Postoperative/drug therapy
• Aged, 80 and over
• Femoral Nerve
• Morphine/therapeutic use
• Morphine/administration & dosage
• Cohort Studies
• Middle Aged
• Pain Management/methods
• Arthroplasty, Replacement, Hip/adverse effects

With continuous increase of the aging population, the number of geriatric patients with fragility hip fractures is rising sharply, and timely surgery remains the mainstay of treatment. However, adequate and effective pain control is the precondition of satisfactory efficacy. This systematic review aimed to summarize the use of fascia iliaca compartment block (FICB) as an analgesic strategy for perioperative pain management in geriatric patients with hip fractures.

PubMed and Embase databases were searched for English published randomized controlled trials (RCTs) reporting application of FICB for pain control of the older adults with hip fractures between January 1^st, 2000, and May 31^st, 2020. The modified Jadad scale was used to evaluate quality of the RCTs included. Primary outcomes of the eligible RCTs were presented and discussed.

A total of 27 RCTs with 2478 cases were included finally. The present outcomes suggested, after admission or in the emergency department (ED), FICB can provide patients with equal or even better pain relief compared with the conventional analgesia methods, which can also reduce additional analgesic consumptions. While, before positioning for spinal anesthesia (SA), FICB is able to offer superior pain control, facilitating SA performance, after surgery FICB can effectively alleviate pain with decreased use of additional analgesics, promoting earlier mobilization and preventing complications.

FICB is a safe, reliable, and easy-to-conduct technique, which is able to provide adequate pain relief during perioperative management of geriatric patients with hip fractures.

Delirium is a common complication after proximal femoral fracture surgery, with pain and opioid consumption as the contributing factors. The administration of intrathecal morphine may decrease these factors postoperatively and potentially reduce delirium.

This research aimed to study the association between the use of intrathecal morphine and the occurrence of delirium.

A retrospective analysis of a prospective register kept in a non-academic hospital in the Netherlands was performed. The register contained data of all patients with proximal femur fractures that were surgically treated with osteosynthesis or prosthesis. Patients receiving spinal anesthesia (SA group) were compared with patients receiving spinal anesthesia with the addition of intrathecal morphine (SIM group). The administration of either SA or SIM was based on the preference of the anesthesiologist. The primary outcome was the incidence of delirium, as defined by the DSM-V classification. The follow-up lasted until hospital discharge. Both univariate and multivariate analyses were performed.

The SA group consisted of 451 patients, and the SIM group included 34 patients. Delirium occurred in 19.7% in the SA group versus 5.9% in the SIM group (P = 0.046). This association remained significant after correction in multivariate analysis (OR of delirium in the SA group, 95% CI: 1.062 - 21.006, P = 0.041). Additionally, multivariate analysis revealed that age, gender, preoperative cognitive impairment, and fracture treatment (osteosynthesis or prosthesis) were independently associated with delirium.

This retrospective study found an independent association between the use of intrathecal morphine and a lower incidence of delirium. This clinically relevant decrease in delirium should be studied in a prospective randomized study.

• Delirium
• Femoral Fractures
• Morphine
• Spinal Anesthesia
• Spinal Injections

Patients with femoral neck fractures often suffer severe pain. This randomized controlled clinical study compared the effect of femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in this population.

Forty-six patients were randomly assigned to one of the two groups: FNB group (femoral nerve block, n=23) or FICB group (fascia iliaca compartment block, n=23). Before positioning for spinal anesthesia, patients received FNB with 15 mL of 0.5% ropivacaine or FICB with 40 mL of 0.5% ropivacaine. Pain was evaluated using a visual analogue scale (VAS) at rest and during hip flexion after admission to the operation room; at 3, 5, 8, and 10 min after analgesia intervention; and during positioning for spinal anesthesia. Positioning was attempted after 10 min of analgesia intervention in each group. Time required to perform spinal anesthesia, quality of positioning, and patient satisfaction were documented.

The VAS scores in the FNB group were significantly lower than those in FICB group at 3 and 5 min after analgesia intervention (P=0.000). However, there were no significant differences in VAS between groups at 8 or 10 min or during positioning.

FNB and FICB produce similar analgesic effects in patients with femoral neck fractures, but FNB has a more rapid onset of pain relief.

• analgesia
• fascia iliaca compartment block
• femoral neck fracture
• femoral nerve block

• Analgesics
• Anesthesia, Spinal
• Bone
• Bupivacaine
• Fascia
• Femoral Nerve
• Fractures
• Nerve Block
• Pain Management
• Ultrasonography

This study aims to investigate the efficiency of fascia iliaca compartment block (FICB) combined with dexmedetomidine (DEX) in postoperative and inflammation management for elder patients after total hip arthroplasty.

The present randomized controlled study included a total of 119 elder patients who received total hip arthroplasty in our hospital from March 2016 to December 2018. These patients were divided into three groups: control group, patients received routine general anesthesia; FICB group, patients received additional FICB after surgery; and combined group, patients received both pre-treatment of DEX and post-treatment of fascia iliaca compartment block. The serum levels of interleukin (IL)-1β, IL-6, and C-reactive protein (CRP) were measured by ELISA. The visual analog scale (VAS) score was measured at 12, 24, 48, and 72 h after surgery, and the patient-controlled intravenous analgesia (PCIA) pressing time within 48 h after surgery was also recorded. The Pittsburgh sleep quality index (PSQI) was used to measure the sleep quality before and at 1 month after surgery.

The VAS scores were significantly lower in patients in the combined group, when compared with the other two groups, at 12, 24, 48, and 72 h after surgery. In addition, the VAS scores at all time points were significantly lower in the FICB group than the control group. The PCIA pressing times were also remarkably lower in the combined group. At 4, 24, 48, and 72 h after surgery, the serum levels of these inflammatory factors were the lowest in the combined group, and the PSQI scores were significantly lower in the combined group, when compared with the other two groups, while the control group had the highest PSQI scores among the three groups. There was no severe side effects and significant difference observed.

FICB combined with DEX reduced the postoperative pain, improved the sleep condition, and decreased the serum levels of inflammatory factors after total hip arthroplasty.

• Dexmedetomidine
• Fascia iliaca compartment block
• Inflammation
• Pain
• Total hip arthroplasty

• fascia iliaca compartment block
• hip fracture
• meta-analysis
• pain control

• Hip Fractures/surgery
• Humans
• Nerve Block/methods
• Pain Management
• Pain, Postoperative/drug therapy

• Analgesics/therapeutic use
• Anesthesiology/methods
• Anesthesiology/standards
• Anesthetics/adverse effects
• Anesthetics/therapeutic use
• Arthroplasty, Replacement, Hip/methods
• Evidence-Based Medicine
• Hip Fractures/surgery
• Humans
• Interdisciplinary Communication
• Nerve Block
• Pain Management
• Patient Safety
• Patient-Centered Care
• Perioperative Care/methods
• Perioperative Period
• Randomized Controlled Trials as Topic
• United States
• United States Agency for Healthcare Research and Quality

• HHSP233201500020I AHRQ HHS

• obturator nerve block
• tans-urethral resection of the bladder tumor
• ultrasound-guided proximal

• analgesia
• fascia iliaca
• femoral
• hip fracture
• nerve block

The present study presented the results of a prospective, randomized controlled trial. The present study enrolled 98 very elderly patients with hip fractures, complicated with at least one cardiovascular, neurological or pulmonary disease, of whom 10 patients were excluded. A total of 88 patients were randomly assigned into 2 groups: i) The control group, receiving traditional analgesia including 50 mg Tramadol and 500 mg paracetamol orally three times a day from admission to surgery; and ii) the study group, receiving ultrasound-guided continuous fascia iliaca compartment block (CFICB), a single 50 ml 0.4% ropivacaine injection with continuous infusion of 0.2% ropivacaine at a dose of 5 ml/h from admission to surgery. The primary outcome measure of pain relief or pain intensity was assessed preoperatively and up to 48 h postoperatively using a visual analog scale (VAS). The results of the present study indicated that in the preoperative period, in the morning of the day of surgery, the VAS pain at rest scores were lower in the study group compared with the control group (P=0.023). The VAS passive movement scores of the study group were also significantly lower compared with the control group 1 h following analgesia at the time of admission (P<0.05) and in the morning of the day of surgery (P<0.05). Scores for patients' satisfaction with the analgesic regimen in the preoperative period were greater in the study group compared with the control group (P<0.001). There was no difference in analgesia-associated side effects between groups. Duration of hospital stay of patients in the control group was significantly longer compared with the study group (P=0.001). Patients in the study group were less likely to have increased complications compared with patients in the control group over the N2-N4 period (from preoperative period to after surgery; P=0.016). The present study concluded that ultrasound guided CFICB was an effective method of providing analgesia for very elderly (≥80 years old) with hip fracture.

• analgesia
• geriatrics
• hip fracture
• pain
• ultrasound-guided fascia iliaca compartment block

• Cognitive impairment
• Emergency care
• Hip fractures
• Pain
• Pain assessment
• Pain management

• ASAP
• Hip fracture
• NHFS
• Spinal
• Transfusion

• fascia iliaca compartment block
• hip fracture
• nerve block
• nerves
• pain

• fascia iliaca block
• femoral nerve block
• meta-analysis
• pain control
• total hip arthroplasty
• total knee arthroplasty

• Arthroplasty, Replacement, Hip
• Arthroplasty, Replacement, Knee
• Fascia/innervation
• Femoral Nerve
• Humans
• Ilium/innervation
• Nerve Block
• Pain, Postoperative/therapy
• Randomized Controlled Trials as Topic

• Aged
• Aged, 80 and over
• Analgesia, Epidural/methods
• Analgesics, Non-Narcotic/administration & dosage
• Analgesics, Non-Narcotic/therapeutic use
• Analgesics, Opioid/administration & dosage
• Analgesics, Opioid/adverse effects
• Analgesics, Opioid/therapeutic use
• Anesthesia, Conduction/methods
• Anesthesia, General/methods
• Anesthesia, Spinal/methods
• Female
• Hip Fractures/drug therapy
• Hip Fractures/surgery
• Humans
• Male
• Nerve Block/methods
• Pain/prevention & control
• Pain Management/methods

• RTF49/0114 The Dunhill Medical Trust

The treatment of hip fractures in the elderly represents a major public health priority and a source of ongoing debate among orthopaedic surgeons and anesthesiologists. Most of these injuries are treated with surgery in an expedient fashion. From the surgical perspective, there are certain special considerations in this population including osteoporosis, pre-existing arthritis, age, activity level, and overall health that contribute to the type of surgical fixation performed. Open reduction and internal fixation versus arthroplasty remain the two major categories of treatment. While the indications and treatment algorithms still remain controversial, the overall goal for these patients is early mobilization and prevention of morbidity and mortality. The use of preoperative, regional anesthesia has aided in this effort. The purpose of this review article is to examine the various treatment modalities for hip fractures in the elderly and discuss the most recent evidence in the face of a rapidly aging population.

• Hip fracture
• arthroplasty
• elderly
• hemiarthroplasty
• open reduction internal fixation
• total hip

• Analgesia
• Anestesia raquídea
• Bloqueo nervioso
• Clinical trial
• Dolor
• Ensayo clínico
• Hemiarthroplasty
• Hemiartroplastia
• Nerve block
• Pain
• Spinal anaesthesia

• Abdominal Muscles
• Analgesia
• Double-Blind Method
• Femoral Neck Fractures
• Humans
• Nerve Block
• Pain, Postoperative/drug therapy
• Prospective Studies

• Beta-endorphin
• Delta opioid receptor
• Dynorphin
• Enkephalin
• Kappa opioid receptor
• Morphine
• Naloxone
• Orphan opioid receptor
• Orphanin/nocicpetin FQ
• mu Opioid receptor

• Affect/drug effects
• Analgesia
• Analgesics, Opioid/pharmacology
• Animals
• Feeding Behavior/drug effects
• Humans
• Learning/drug effects
• Memory/drug effects
• Narcotic Antagonists/pharmacology
• Opioid Peptides/pharmacology
• Opioid Peptides/physiology
• Opioid-Related Disorders
• Pain Management
• Receptors, Opioid/agonists
• Receptors, Opioid/physiology

• Femoral blockade
• Hip fracture
• Opioid
• Pain
• Side effects

• Analgesia
• Elderly
• Hip fractures
• Pain
• Proximal femoral fractures

Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile.

• injury
• nerve block
• outcomes
• regional anesthesia
• trauma

• foot and ankle surgery
• fragility fractures
• geriatric medicine
• geriatric trauma
• metabolic bone disorders
• nonoperative spine
• osteoporosis
• systems of care
• trauma surgery
• upper extremity surgery

• Fascia iliaca compartment nerve block
• Femoral bone fracture
• Postoperative pain
• Surgery

• Battlefield anesthesia
• Orthopedic trauma
• Regional anesthesia
• Regional anesthesia techniques
• Risks and benefits of regional anesthesia

• Anesthesia, Conduction/methods
• Humans
• Orthopedic Procedures/methods
• Warfare
• Wounds and Injuries/epidemiology
• Wounds and Injuries/surgery