Saturday, 24 August 2019

Femoral Nerve Catheters Improve Home Disposition and Pain in Hip Fractures... maybe



There has been a push to perform nerve blocks for femoral neck fractures. Typically, these are single injections with a long acting anaesthetic. But continuous infusions through a femoral nerve catheter may supply better and longer lasting analgesia. Perhaps this could decrease complications from parenteral medications, allow for earlier mobilisation and get patients home faster?

This group from Stanford retrospectively reviewed health records of all geriatric hip fractures during a 4-hour period. About halfway through this time, this hospital started a hip fracture protocol that involved insertion of an ultrasound guided indwelling continuous female nerve catheter (CFNC).

They compared the before group that got standard analgesia vs. the CFNC. They sought to answer three questions; do CFNC improve home disposition rates, do they decrease pain scores & narcotic consumption, and does it decrease opioid-related side effects.  

Results?

43% of the patients getting CFNC were discharged home compared to 7% of the standard group. In addition, the patients with nerve catheters had lower pain scores, less opioids, and less side effects.

Sounds great!

But unfortunately, there are some big limitations.

They only included 29 patients. (I find it hard to believe that this was “all” patients with fractures at Stanford over 4 years… selection bias?) So, 43% vs. 7% is really 6 vs. 1 patient. This is hardly strong evidence.

Chart reviews are always problematic, and it does not look like this one followed the usually recommended methods. Of course, patients were not randomised. As such, there may have been some further selection bias.

I also wonder if the new protocol introduced other aspects of care that led to improvements. Perhaps this is why the “after” group looked better.

Nevertheless, I think the idea of femoral nerve catheters is quite compelling. Hopefully we can get further data to inform our practice.  


Covering:

Arsoy D, Huddleston JI, Amanatullah DF, et al. Femoral Nerve Catheters Improve Home Disposition and Pain in Hip Fractures Treated with Total Hip Arthroplasty. J Arthro 2017;32:3434-3437. [link to full text]


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