Nurse-performed ultrasound-guided nerve block for hip fracture patients

Abstract

Background: Ultrasound-guided fascia iliaca compartment block $US6FICB% is an important procedure for minimising opioid use during perioperative pain management for the expanding demographic of elderly patients with hip fractures. Nurse anaesthetists with specialised skills are emerging as valuable assets for the efficient delivery of this nerve block. Despite the growing implementation of US6FICB, studies have not yet detailed how its pain relief effects differ between men and women, or the differentiation of the effect on pain at rest and with movement. This study aims to evaluate the analgetic effect of US6FICB administered by nurse anaesthetists in patients with hip fractures, with a specific focus on variations based on the patient's sex and the intensity of pain at rest and during movement. Design: Prospective observational study involving systematic data collection to observe the effects of US6FICB in a clinical setting. Method: Pain intensity at rest and with movement was recorded on a numeric rating scale $0710%. Then, nurse anaesthetists administered a US6FICB. After 60 minutes, pain intensity at rest and during movement were recorded once more. A decrease of 1.5 points was deemed clinically significant. Results: Of the 33 patients with complete datasets, the mean pain reduction after US6FICB was 1.4 $95% CII 0.572.4% for pain at rest and 2.6 points $95% CII 1.873.5% for pain during movement. Clinically significant pain relief was noted in 17 patients $51.5%% at rest and 23 patients $69.7%% during movement. A high initial pain intensity at rest was a statistically significant predictor for the procedure's effect (odds ratio 1.6; 95% CII 1.172.3; p<0.01%. The study did not reveal significant sex-based differences, but the sample size may not have been adequate for this determination. No serious adverse effects were recorded. Conclusion: Nurse anaesthetist-delivered US6FICB can offer notable pain alleviation for hip fracture patients, particularly for movement-induced pain and for patients initially reporting high pain intensities.