Six high strength studies (Fletcher et al 10, Foss et al 11, Haddad et al 12, Monzon et al 13, Mouzopoulos et al 14, and Yun et al 15) and one moderate strength study (Matot, 2003 16) showed beneficial outcomes. Six studies inclusive of 593 patients used a prospective randomized clinical trial design to assess the effect of regional analgesia in reducing preoperative pain after hip fracture upon presentation to the emergency department (Fletcher et al 10, Foss et al 11, Haddad et al 12, Monzon et al 13, Mouzopoulos et al, and Yun et al 15).
These studies all used a technique of administration of a local anesthetic that results in temporary loss of nerve function in the fascia iliaca or femoral compartment of the injured hip. In each study, the patients who received this agent reported a significant reduction in reported preoperative pain on a visual analog scale. One of these studies reported improved reported pain at the time of administering spinal anesthesia.
The studies available to date report improved pain scores preoperatively. Future research should focus on the impact of early regional analgesic technique on patient outcome. Several important outcomes need to be studied: assessment of total opioid usage pre- and post-op, incidence of delirium during hospital stay, and length of stay; There may be others.