Name 37

Adam Dryden, RN, DNP, CRNA

DNP Nurse Anesthesia

Evaluation of Regional Anesthesia in Hip Fracture Patients: A Retrospective Review

Project Category:  Original Research 

Project Team: Adam Dryden, DNP, CRNA, Rachel Valentino, DNP, CRNA

Abstract

Background: The use of peripheral nerve blocks (PNBs) is an important analgesic technique for patients who have suffered from hip fractures and are utilized to improve perioperative outcomes. The aim of this evidence-based quality improvement project was to compare the patient outcomes of those who did not receive PNBs prior to the implementation of a standing order compared to patients who received PNBs.

Methods: A retrospective review was conducted for patients at a Level-1 trauma center for patients who underwent hip fracture surgery. A consecutive sampling technique was used to identify 30 patients before and 30 patients after the implementation of the standing order for preemptive block placement in fracture patients. Postoperative outcomes such as morphine milligram equivalents, length of stay, pain scores, incidence of surgical complications, time to first ambulation were collected via the electronic medical record.

Results: Morphine milligram equivalent (MME) consumption intraoperatively (p=0.03) and 24 hours post operatively (p=0.037) was less in the intervention group. MMEs 48 hours post-op (p=0.253) and length of stay (p=0.481) were not clinically significant. Pain scores at various times were not found to be statistically significant between groups.

Conclusion: The use of PNBs in traumatic hip fractures is an evidence-based practice intervention to improve outcomes and optimize patient recovery. This quality improvement project showed how PNBs can lower opioid consumption without altering pain scores. Several confounding variables, incomplete documentation and small sample size may have led to a lack of statistical significance.

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