Ultrasound Guided Femoral Nerve Blocks and the Management of Elder Patients with Hip Fractures

Abstract

Hip fractures in the elder population are not infrequent and often result in untreated pain or large quantities of opioid administration. Femoral nerve blocks (FNBs) offer a safe, effective method for improving pain control in the setting of hip fracture, which can be initiated in the emergency department (ED). The use of ultrasound has been shown to improve efficiency and accuracy of FNB with an added benefit of reducing the volume of local anesthetics utilized compared to landmark technique. Prior studies have shown that ultrasound training for FNB proficiency can be easily accomplished in the ED setting. There are relatively few known complications associated with FNBs and published studies on ultrasound-guided FNBs have reported zero complications. After reviewing the available literature, we believe the emergency physician is well suited to perform ultrasound guided FNBs; which will lead to improved pain control, decrease opioid requirements, and can potentially reduce medication-induced delirium in the elder population requiring lower extremity pain control.