Fascia Iliaca Regional Anesthesia in Hip Fracture Patients Revisited: Which Fractures and Surgical Procedures Benefit Most?

OBJECTIVES: Perioperative fascia-iliaca regional anesthesia (FIRA) decreases pain in hip fracture patients. The purpose of this study is to determine which hip fracture types and surgical procedures benefit most. DESIGN: This is a prospective observational study compared to a retrospective historical control. PATIENTS/PARTICIPANTS: Patients older than 60 years who received perioperative FIRA were compared to a historical cohort not receiving FIRA. SETTING: This study was conducted at a level 1 trauma center. MAIN OUTCOME MEASUREMENTS: The primary outcome was morphine milli-equivalents (MME) consumed during the index hospitalization. Fracture pattern specific preoperative and postoperative MME consumption and surgical procedure specific postoperative MME consumption was compared between the FIRA and non-FIRA groups. RESULTS: A total of 949 patients were included in this study, with 194 (20.5%) patients in the prospective protocol group. There were no baseline differences between cohorts. Preoperatively, only femoral neck fracture patients receiving FIRA used fewer MME (P<0.001). Postoperatively, femoral neck fracture patients receiving FIRA used fewer MME on postoperative day (POD) 1 (P=0.027) and intertrochanteric fracture patients used fewer MME on POD1&2 (P=0.013; P=0.002). Cephalomedullary nail patients receiving FIRA used fewer MME on POD1&2 (P=0.004;P=0.003). Hip arthroplasty patients receiving FIRA used fewer MME on POD1 (P=0.037). Percutaneous pinning and sliding hip screw patients had no significant MME reduction from FIRA. CONCLUSIONS: Preoperatively, patients with femoral neck fractures benefit most from FIRA. Postoperatively, patients with femoral neck fractures or intertrochanteric fractures both benefit from FIRA. Patients undergoing cephalomedullary nail fixation or hip arthroplasty benefit most from FIRA postoperatively. LEVEL OF EVIDENCE: III.