Advantages of the standardized use of preoperative fascia iliaca block versus conventional analgesia in older adults with fragility hip fracture: A retrospective cohort study at two hospitals in Colombia.

Abstract

Introduction: Hospital admission due to fragility hip fracture has increased significantly in recent years. In patients with hip fracture, perioperative pain management is usually with opioids, whose dosage is difficult to adjust and have many side effects, especially in older adults. The purpose of this study was to determine the impact and the advantages of the implementation of the fascia iliaca blockade in older adults with hip fracture due to fragility included in the Orthogeriatric Clinical Care Center of the Fundación Santa Fe de Bogotá and the San José Infantil University Hospital in Bogotá, Colombia. The primary outcome of our study is the incidence of delirium during hospitalization. Methods: A retrospective observational cohort study was conducted. The data was collected from patients older than 65 years treated for a fragility fracture of the hip in two fourth-level hospitals in Bogotá, Colombia from the beginning of 2019 until the end of 2020. Results: A sample of 218 patients was obtained, of which 119 received conventional analgesic management. 99 patients underwent fascia iliaca blockade. No significant difference was found between the use of the block and the development of delirium (p = 0.442). There was a higher consumption of opioids in the conventional analgesia group compared to the block group (27.61 mg vs 16.34 mg, respectively, p = 0.003), longer duration of the surgical procedure (90.84 vs 81.08 min, respectively, p = 0.030) and longer hospital stay (6.06 vs 5.41 days, respectively, p = 0.641). Conclusions: While this study found no significant difference in the incidence of delirium, fascia iliaca blockade was associated with significant reductions in opioid consumption and shorter procedural times. These findings suggest that fascia iliaca blockade may improve pain management efficiency in older adults with hip fractures.