Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jinlei Li

Second Advisor

Paul Heerdt

Abstract

FEMORAL AND LATERAL FEMORAL CUTANEOUS NERVE BLOCK IN ELDERLY HIP FRACTURE – A PILOT STUDY. Matthew J. Erlendson, Feng Dai*, and Jinlei Li**. *Department of Biostatistics, Yale University School of Public Health, New Haven CT. **Department of Anesthesiology, Yale University School of Medicine, New Haven, CT.

Research has shown alternative and adjunctive analgesic approaches that reduce perioperative opioid requirements are associated with lower rates of postoperative opioid use and misuse. Regional anesthesia techniques that produce site-specific analgesia by blocking nerves with local anesthetics have emerged as an attractive modality for controlling postoperative pain and reducing short-term opioid requirements. Clinical research has demonstrated that this approach is effective following a variety of procedures and suggests that combining steroids with local anesthetics may prolong block duration and extend opiate-sparing analgesia. However, limited research exists in elderly hip fracture patients, a population especially vulnerable to opiate side effects and dependence. We hypothesized that combined femoral and lateral femoral cutaneous nerve blocks performed with a mixture of ropivacaine, dexamethasone sodium phosphate, and methylprednisolone acetate in elderly patients undergoing hip fracture repair can decrease both short- and long-term-opioid use relative to patients without nerve blocks. To test this hypothesis, a single-institution retrospective chart review cohort study was performed. The study was designed to evaluate differences between block and no block groups in perioperative opiate use, expressed as milligram morphine equivalents (MME) over fixed time intervals, and the Narx score, an algorithm based upon postoperative electronic prescribing data. In addition, records were evaluated for evidence of the potential steroid side effects, hyperglycemia and leukocytosis. Study results demonstrated that block patients had a lower MME per hour over the first 24 hours. However, there were subsequently no other differences in MME used and pain scores recorded on a visual analog scale in the patient record were the same for both groups. Consistent with limited short-term effects on opioid consumption, no differences in opioid prescriptions at discharge and three-months were observed. Data did not indicate hyperglycemia and/or leukocytosis in the perioperative period resulting from perineural steroid injection. Overall, data compiled from the medical records of elderly patients undergoing hip fracture repair indicate that while dual nerve blocks performed with a mixture of local anesthetic and steroids can decrease short-term opioid use relative to patients with no nerve blocks, this effect is not prolonged.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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