An Evaluation of a Nerve Block Protocol in Hip Fracture Patients

BACKGROUND/PURPOSE: Pain management for hip fracture patients before surgery is critical. Literature highlights the success of local, single injection nerve blocks to aid in preoperative pain management. A local hospital implemented a preoperative, single injection nerve block protocol in March 2018. This quality improvement project investigated organization protocol compliance, and if the preoperative nerve block protocol reduces hip fracture pain, use of systemic opioid analgesics decreases incidence of adverse opioid effects, and reduces cost of care. SUBJECTS: Patients ages eighteen and older admitted with the primary diagnosis of an operable isolated hip fracture (n=100). METHODS: Data measures were extracted from the electronic health records and the trauma registry and were entered into REDCap encrypted software. ANALYSIS: Data was analyzed using SAS statistical software to verify whether the intervention was successful in meeting cost, quality, and compliance measures. RESULTS: Results were not statistically significant in reducing narcotic use before (p=0.80; p=0.39) and after (p=0.23; p=0.10) surgical correction, nor was there statistically significant change in adverse effects (p=0.10) or length of stay (p=0.90). However, there was a statistically significant reduction in preoperative pain levels following nerve block administration (p\u3c0.0001). Protocol compliance was 66% over seven months. CONCLUSION: The results of this project were consistent with the literature; nerve block injection may reduce preoperative pain for patients with an operable hip fracture. Further investigation is needed to determine if narcotic use and length of stay could be impacted if time variability in nerve block administration were reduced and if protocol compliance were increased