Use of neurolytic nerve blocks and mortality in nonoperative management of hip fracture patients : a nationwide population study in the Netherlands.

Abstract

Aims: Nonoperative management may be suitable for very frail hip fracture patients; in these instances, neurolytic nerve blocks with phenol could act as a long-term analgesic, with potentially fewer disadvantages compared with systemic analgesia. While neurolytic nerve blocks are being used more frequently in end-of-life care, there are limited data on how often they are used, and what long-term outcomes they achieve in patients with hip fractures. This study aims to evaluate the association between neurolytic nerve block use and mortality in patients with hip fractures managed nonoperatively, while also exploring the characteristics of patients who receive these blocks.

Methods: A retrospective population-based cohort study was conducted including patients with a hip fracture aged 70 years and older, who were treated nonoperatively between 1 January 2024 and 31 December 2024. The primary outcome was mortality, comparing patients who received a neurolytic block with those who did not.

Results: Of 1,415 nonoperatively managed patients (mean age 86 years (SD 6.75)), 633 (45%) received neurolytic nerve blocks. These patients were more frail, had greater levels of dependence, malnourishment, and immobility, and were diagnosed with a displaced fracture more often than those who did not receive a block. Nerve block patients also showed significantly lower mortality at seven days (24.9% (n = 120) vs 39.0% (n = 138); p < 0.001), but higher mortality at three months (74.9% (n = 361) vs 68% (n = 68.1); p = 0.036) and six months (89.7% (n = 384) vs 72.9% (n = 258); p = 0.027). The adjusted hazard ratio at 30 days was 0.73 (95% CI 0.61 to 0.88; p = 0.001).

Conclusion: Neurolytic nerve blocks have emerged as part of nonoperative hip fracture management in the Netherlands and are associated with lower short-term mortality. Furthermore, our nonoperatively managed cohort appeared less frail than earlier Dutch cohorts, suggesting a broadening of patient selection.