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

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Abstract
Background Various nerve blocks using local anaesthetic agents have been used in order to reduce pain after hip fracture, and subsequent surgery. Objectives To determine the effects of nerve blocks (inserted either pre‐operatively, operatively or post‐operatively) that may be used to relieve pain after a hip fracture. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2), MEDLINE (1966 to May Week 2 2008), EMBASE (1988 to 2008 Week 21), CINAHL (1982 to May Week 4 2008) and reference lists of relevant articles. Selection criteria Randomised and quasi‐randomised trials involving the use of nerve blocks as part of the care of a hip fracture patient. Data collection and analysis Two review authors independently assessed trials for inclusion, trial quality by use of a nine item scale and extracted data. Wherever appropriate, results of outcome measures were pooled. Main results Seventeen randomised or quasi‐randomised trials involving 888, mainly elderly and female, participants were included. Nine trials related to insertion of a nerve block pre‐operatively and eight to peri‐operative insertion. Nerve blocks resulted in statistically significant reductions in reported pain levels and in the quantity of parenteral or oral analgesia administered to control pain from the fracture or during surgery. There were few reported complications, none major, associated with nerve blocks. The limited data for other outcomes, such as medical complications and mortality, showed a general lack of differences between nerve block and control group participants. There were no notable adverse reactions or complications from the nerve blocks. Authors' conclusions Because of the small number of participants included in this review, limitations in the measurement and reporting of outcomes and the differing types of nerve blocks and timing of insertion, it is not possible to determine if nerve blocks confer any significant clinical benefit when compared with other analgesic methods as part of the treatment of a hip fracture. They do, however, reduce the degree of pain experienced by the patient from the hip fracture and subsequent surgery. Further randomised trials with larger numbers of participants and full reporting of clinical outcomes would be justified.

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