.jpg "Kristin Salottolo, MPH photo")
Kristin Salottolo, MPH
Clinical Epidemiologist
St. Anthony Hospital
Lakewood, CO
Disclosure information not submitted.
Landon Fine, DO
Surgeon
Parker Adventist Hospital, United States
Disclosure information not submitted.
Francie Ekengren, MD
Surgeon
Wesley Medical Center, United States
Disclosure information not submitted.
Robert Madayag, MD
Trauma medical Director
Saint Anthony Hospital, United States
Disclosure information not submitted.
Allen Tanner, MD
Trauma Medical Director
Duke University Hospital, United States
Disclosure information not submitted.
Philip Roman, MD, MPH
Surgeon
St Anthony Hospital, United States
Disclosure information not submitted.
David Bar-Or, MD
Director of ION Research
Swedish Medical Center Cherry Hills Campus, United States
Disclosure information not submitted.
Title: Does Time to Surgery for Traumatic Hip Fracture Impact the Efficacy of Fascia Iliaca Blocks?
Introduction: Outcomes following traumatic hip fracture have shown to be significantly improved with surgery within 24h of arrival. We recently completed a prospective, observational study evaluating the effect of fascia iliaca compartment block (FICB) on pain outcomes in hip fracture patients; FICB was more effective than systemic analgesia for pain but not opioid use or delirium. For this a priori analysis, we sought to determine whether differences exist in efficacy and safety of FICB once stratified by time to surgery.
Methods: Geriatric trauma patients admitted to five trauma centers within 12h of hip fracture were included; patients receiving FICB postoperatively were excluded (n=29). The primary exposure was analgesia modality: adjunctive FICB or systemic analgesics (no FICB). Study endpoints were incidence of delirium through 48h postoperatively (%), analgesic complications (%), mean preoperative oral morphine equivalents (OMEs), and mean pain at arrival, admission, preoperatively, and postoperatively (0-10 NRS scale). Analyses were stratified by time to surgery: ≤ 24h (timely) and > 24h from arrival (delayed).
Results: Of 488 patients, 377 (77%) had timely surgery and 111 (23%) had delayed surgery. FICB use was similar with timely and delayed surgery (71% vs. 76%). In the timely surgery group, there were no differences by FICB use for delirium (4.9% vs. 4.6%, p=0.91), analgesic complications (16.7% vs. 11%, p=0.24), or OMEs (25.4mg vs. 27mg p=0.72). However, pain was improved with FICB than no FICB, at admission (5.3 vs. 6.4, p< 0.001) and preoperatively (3.9 vs. 4.8, p=0.002), and postoperatively, but not significant (3.0 vs. 3.5, p=0.08). In the delayed surgery group, there were no differences by FICB use for delirium (p=0.27), analgesic complications (p=0.72), and pain at all time points. OME use was trending lower with FICB than no FICB (42.5mg vs. 63.0mg, p=0.07).
Conclusions: While there was no statistically significant effect modification for FICB efficacy by time to surgery, patients who had timely surgery improved pain with FICB compared to systemic analgesia. The treatment effect of FICB on reduced opioid use was more evident for patients who had delayed surgery. FICB did not exhibit a treatment effect for delirium or complications, with early or delayed surgery.