What happens when EPs offer continuous nerve blocks for fracture patients?

  • Am J Emerg Med

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Emergency physicians (EPs) safely began continuous nerve blocks in this group of adults with acute fracture.
  • This tactic could help reduce opioid use.

Why this matters

  • Hip and rib fractures call for aggressive pain control.
  • EPs give single-shot nerve blocks to provide regional anesthesia. 
  • Continuous blockade might reduce opioid consumption.

Key results

  • Mean patient age, 65.9 (range, 28-94) years.
  • 5 patients required ICU admission.
  • Mean duration of blockade, 3.4 days.
  • Hourly opioid use fell by 58% after vs before catheter placement.
  • Most common complication: dislodged catheter.
  • 4 patients developed pneumonia, 2 of whom had hip fracture.
  • No pneumothoraces, hemothoraces, catheter-related infections, or hematomas.
  • 8 patients were discharged to home with catheter in place.

Study design

  • Retrospective, observational, single-center cohort study (n=41).
  • In 2016, this center decided to offer continuous nerve blocks to a convenience sample of adults with new hip or rib fracture. 
  • Patients received ultrasound-guided nerve-block over-the-needle catheters and continuous ropivacaine infusion pumps.
  • Upon discharge from hospital, patients were offered option to keep catheter and pump running, with ED return visit for removal.
  • Researchers reported a range of outcomes to describe their initial experience.
  • Funding: None.

Limitations

  • Nonrandomized, non-placebo-controlled study.