Ultrasound Guided Femoral Nerve Blocks and the Management of Elder Patients with Hip Fractures

Hip fractures are a common injury in the elder population with over 250,000 cases in 2010 occurring in patients of age 65 and older [1]. Hip fractures are estimated to cost nearly 2.9 billion dollars per year [2]. Adding to these costs are the potential problems that can complicate elder patients’ hospital course such as urinary tract infections and the development of delirium. In fact, delirium in elder patients who are admitted to intensive care units has been demonstrated to increase mortality by 26% when compared with those elder patients who do not develop delirium [3]. Several hypotheses exist as to why elder patients develop delirium such as poly-pharmacy, poor control of pain, environmental changes or direct opioid side effects; however there has been no overwhelming evidence to support one hypothesis over another [4,5]. Several studies have been conducted demonstrating the feasibility of femoral nerve blocks (FNBs) from the emergency department [5-10]. Furthermore, numerous studies demonstrate improved pain control and decreased opioid use with implementation of femoral nerve blocks [11,12]. Despite the evidence, institutions often face difficulties when implementing FNB protocols. In fact, Holdgate et al. revealed that of 36 emergency departments in Australia, in patients who presented with hip fracture (n = 645), only 7% received a FNB [13]. Moreover, Mittal and Vermani conducted a national survey in the United Kingdom (UK) and found that 74% (n = 230) of the UK EDs contacted had ultrasound access. However, only 10% regularly administered ultrasound guided FNBs [14]. In this review, we summarize the use and benefits of FNBs, particularly with regard to hip fractures in the elder population. We also aim to highlight a need for further research into the possible reduction of delirium in the elder population.