ArticleGeriatric orthopaedic surgery & rehabilitation2012
Peridural Anesthesia or Ultrasound-Guided Continuous 3-in-1 Block: Which Is Indicated for Analgesia in Very Elderly Patients With Hip Fracture in the Emergency Department?
Article in Geriatric orthopaedic surgery & rehabilitation, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 4 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 4 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Ultrasound-guided peripheral nerve blocks for preoperative pain management in hip fractures: a systematic review.BMC anesthesiology · 2022Pooled it
- Peripheral nerve blocks for hip fractures in adults.The Cochrane database of systematic reviews · 2020Pooled it
- Peripheral nerve blocks for hip fractures.The Cochrane database of systematic reviews · 2017Pooled it
- Mode of anesthesia, mortality and outcome in geriatric patients.Zeitschrift fur Gerontologie und Geriatrie · 2014Pooled it
- Association of Peripheral Nerve Block with Postoperative Myocardial Injury in High-risk Cardiac Older Adults Undergoing Hip Fracture Surgery: A Two-center Retrospective Cohort Study.Anesthesiology · 2026Article
- Ultrasound guided femoral nerve blocks as a compulsory pain protocol in femoral neck fractures.World journal of orthopedics · 2025Article
- Orthogeriatric multidisciplinary care for hip fractures in emergency department reduces length of stay: a retrospective cohort study.BMC emergency medicine · 2025Observational
- The impact of loco-regional anaesthesia on postoperative opioid use in elderly hip fracture patients: an observational study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Observational
- Implementing Regional Nerve Blocks in Hip Fracture Programs: A Review of Regional Nerve Blocks, Protocols in the Literature, and the Current Protocol at The Queen's Medical Center in Honolulu, HI.Hawai'i journal of health & social welfare · 2019Review
- Ultrasound-guided continuous fascia iliaca compartment block for pre-operative pain control in very elderly patients with hip fracture: A randomized controlled trial.Experimental and therapeutic medicine · 2018Article
- [Anesthesiological care of trauma patients in orthogeriatric co-management].Der Anaesthesist · 2017Review
- The Challenges of Anaesthesia and Pain Relief in Hip Fracture Care.Drugs & aging · 2017Review
- [Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients].Zeitschrift fur Gerontologie und Geriatrie · 2016Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe aim of our study was to investigate the clinical relevance of preoperative acute pain management and cardiovascular stability by ultrasound-guided continuous 3-in-1 nerve block in very elderly patients with hip fracture when compared to epidural anesthesia (PDA).
methodsTo study the analgesic effect, we enrolled 37 very elderly patients with hip fractures, of whom 3 patients with dementia had to be excluded. Thus, 34 patients were randomized to 1 of the 3 groups: group A (ultrasound-guided continuous 3-in-1 block, bupivacaine; n = 10, dropout rate: 0), group B (PDA, bupivacaine; n = 14, dropout rate: 8), and group C (systemic pain therapy, piritramide/paracetamol; n = 10, dropout rate: 0). Pain intensity was assessed preoperatively and up to 24 hours postoperatively using a visual analog scale, verbal rating scale, analgesic consumption, scale of well-being, and cardiocirculatory parameters (eg, serum troponin T).
resultsOur data show that in the preoperative period both regional anesthesia (RA) procedures (analgesia responders after 1 hour: 86.7% and 100%; P = .001) were superior to systemic analgesia (analgesia responders: 46.7%), and the rescue medication requirement in the 2 RA groups was significantly lower (P = .02). Serum troponin T level increased only in the systemic analgesia group (P = .04). In the emergency department, the disadvantage of PDA in geriatric patients with hip fracture was the fact that procedures were more complex, resulting in a high dropout rate (57.1%). The use of PDA has to be critically discussed for ethical concerns.
conclusionIn the specific situation of acute hospital admission, the ultrasound-guided continuous 3-in-1 block appears to be indicated as a stress-free means of providing adequate preoperative pain relief in very elderly patients with hip fracture. However, these findings should be corroborated by studies involving larger numbers of patients.
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