Amin Nirav H, West Jacob A, Farmer Travis, Basmajian Hrayr G
Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
Loma Linda University, Loma Linda, CA, USA.
Geriatr Orthop Surg Rehabil. 2017 Dec;8(4):268-275. doi: 10.1177/2151458517734046. Epub 2017 Oct 13.
Hip fracture is a common occurrence in the elderly population with high morbidity and mortality due to postoperative pain and opioid use. The goal of this article is to review the current literature on the neuroanatomy of the hip and the use of localized nerve block in controlling hip fracture pain.
A thorough search of MEDLINE/PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted using the search terms "hip fracture" and "fascia iliaca block (FICB)." An additional search was conducted utilizing multiple search terms including "hip fracture," "greater trochanter," "femur," "hip," "anatomy," "neuroanatomical," and "anatomic." Each search result was investigated for cadaveric studies on the innervation of the trochanteric region.
Twenty-five clinical studies examining the use of FICBs in hip fracture patients were identified. These studies show that FICB is safe and effective in controlling perioperative pain. Additionally, FICB has been shown to decrease opioid requirement and opioid-related side effects. Neuroanatomical studies show that the hip capsule is innervated by contributions from the femoral, obturator, sciatic, and superior gluteal nerves. Imaging studies suggest that FICB anesthetizes these branches through localized spread along the fascia iliaca plane. Cadaveric evidence suggests that the greater trochanter region is directly innervated by a single branch from the femoral nerve.
The proven efficacy of nerve blocks and their anatomic basis is encouraging to both the anesthesiologist and orthopedic surgeon. Their routine use in the hip fracture setting may improve patient outcomes, given the unacceptably high morbidity and mortality associated with opioid use.
Localized nerve blocks, specifically FICB, have been shown to be safe and effective in managing acute hip fracture pain in geriatric patients, leading to decreased opioid use. Knowledge of the hip neuroanatomy may help guide future development of hip fracture pain blockade.
髋部骨折在老年人群中很常见，由于术后疼痛和阿片类药物的使用，其发病率和死亡率都很高。本文的目的是综述当前关于髋部神经解剖学以及局部神经阻滞在控制髋部骨折疼痛方面应用的文献。
使用搜索词“髋部骨折”和“髂筋膜阻滞（FICB）”对MEDLINE/PubMed、Embase和Cochrane系统评价数据库进行了全面检索。还使用了多个搜索词进行额外检索，包括“髋部骨折”、“大转子”、“股骨”、“髋部”、“解剖学”、“神经解剖学”和“解剖的”。对每个搜索结果进行调查，以查找关于转子区神经支配的尸体研究。
确定了25项研究髋部骨折患者使用FICB的临床研究。这些研究表明，FICB在控制围手术期疼痛方面是安全有效的。此外，FICB已被证明可减少阿片类药物的需求量以及与阿片类药物相关的副作用。神经解剖学研究表明，髋关节囊由股神经、闭孔神经、坐骨神经和臀上神经的分支支配。影像学研究表明，FICB通过沿髂筋膜平面的局部扩散麻醉这些分支。尸体研究证据表明，大转子区由股神经的单个分支直接支配。
神经阻滞已证实的疗效及其解剖学基础对麻醉医生和骨科医生都很有鼓舞作用。鉴于与阿片类药物使用相关的发病率和死亡率高得令人无法接受，在髋部骨折情况下常规使用神经阻滞可能会改善患者的预后。
局部神经阻滞，特别是FICB，已被证明在管理老年患者急性髋部骨折疼痛方面是安全有效的，可减少阿片类药物的使用。了解髋部神经解剖学可能有助于指导未来髋部骨折疼痛阻滞的发展。
