Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Freeman Hospital, Newcastle upon Tyne, UK.
Can J Anaesth. 2022 Sep;69(9):1139-1150. doi: 10.1007/s12630-022-02279-0. Epub 2022 Jul 12.
Peripheral nerve blocks improve analgesia following hip fracture; however, there are little published data on safety and outcomes of continuous regional anesthetic techniques. Our institution offers pre- and perioperative, anesthesiologist-delivered ultrasound-guided suprainguinal fascia iliaca catheters (FICs) to patients with hip fracture. We aimed to document the safety profile of this technique and establish whether there are any significant clinical benefits in outcomes measured by the UK National Hip Fracture Database.
We performed a single-centre historical cohort study of 2,187 patients admitted to our institution with hip fracture over a 5.75-year period. Of these, 915 were treated with FIC and 1,272 received standard care (single-shot block). To control for baseline differences between these two cohorts, we used propensity score matching and exact matching, resulting in two well-matched groups of 728 patients treated with an FIC and standard care.
No serious complications were observed as a result of an FIC. Unplanned removal occurred in 146/852 (17.1%) patients with documented data. No differences in 30-day mortality, pressure ulcer rates, or hospital length of stay were observed between the matched groups. The percentage of patients who were discharged to their usual residence was 79.3% in the FIC cohort vs 75.1% in the standard care cohort (difference, 4.2%; 95% confidence interval, -0.1 to 8.4; P = 0.06).
Our single-centre propensity-matched historical cohort study suggests that ultrasound-guided suprainguinal fascia iliaca catheterization is a safe technique for patients with hip fracture and that our service is deliverable and sustainable within the UK's National Health Service. This study did not show statistically significant differences in outcomes between patients treated with FIC and standard care. An adequately powered multicentre randomized controlled trial comparing these approaches is warranted.
周围神经阻滞可改善髋部骨折后的镇痛效果；然而，关于连续区域麻醉技术的安全性和结果的文献报道较少。我们机构为髋部骨折患者提供术前和围手术期由麻醉医师实施的超声引导下股外侧肌筋膜髂骨导管（FIC）。我们旨在记录该技术的安全性，并确定通过英国国家髋部骨折数据库测量的结果是否有任何显著的临床获益。
我们对 5.75 年内我院收治的 2187 例髋部骨折患者进行了单中心历史队列研究。其中 915 例接受 FIC 治疗，1272 例接受标准治疗（单次阻滞）。为了控制这两组之间的基线差异，我们使用倾向评分匹配和精确匹配，得到了两组匹配良好的 728 例接受 FIC 和标准治疗的患者。
FIC 未引起严重并发症。有记录数据的 852 例患者中有 146 例（17.1%）出现计划外拔除。匹配组之间在 30 天死亡率、压疮发生率或住院时间方面无差异。FIC 组中有 79.3%的患者出院回家，而标准治疗组为 75.1%（差异 4.2%；95%置信区间，-0.1 至 8.4；P=0.06）。
我们的单中心倾向评分匹配历史队列研究表明，超声引导下股外侧肌筋膜髂骨导管置管术是髋部骨折患者的一种安全技术，我们的服务在英国国民保健制度内是可行和可持续的。本研究未显示 FIC 治疗与标准治疗的患者在结局方面存在统计学显著差异。需要进行一项比较这些方法的充分样本量多中心随机对照试验。
