Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures

Parker, Martyn J, Griffiths, Richard, Appadu, Bal, Parker, M J, Griffiths, R, Appadu, B N

Various nerve blocks using local anaesthetic agents have been used in order to reduce pain after hip fracture. To determine the effects of nerve blocks (inserted either pre-operatively, operatively or post-operatively) as part of the treatment for a hip fracture. The Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, and bibliographies of trial reports were searched. Date of the most recent search: April 1998. Randomised and quasi-randomised trials involving the use of nerve blocks as part of the care of a hip fracture patient. Two reviewers independently assessed trial quality, by use of an eight item scale, and extracted data. Wherever appropriate, results of outcome measures were pooled. Six randomised or quasi-randomised trials involving 229 patients were included. One trial related to insertion of a nerve block pre-operatively and the remaining five, to peri-operative insertion. Nerve blocks resulted in a reduction of the quantity of parental or oral analgesia administered to control pain from the fracture/operation or during surgery. It was not possible to demonstrate if this reduction in analgesia use was associated with any clinical benefit. Because of the small number of patients included in this review and the differing type of nerve blocks and timing of insertion, it is not possible to determine if nerve blocks confer any benefit when compared with other analgesic methods as part of the treatment of a hip fracture. Further trials with larger numbers of patients and full reporting of clinical outcomes would be justified.