Loading...
In patients with hip fracture — who are often older, with multiple comorbidities — both pain and its treatment with opioids can lead to delirium and other adverse effects. Nerve blocks are alternatives to opioids for these patients, but how do these approaches compare?
In a randomized trial, 104 patients with hip fracture (median age, 79 years) received intravenous fentanyl or ultrasound-guided femoral nerve block in the emergency department. Importantly, the study was double-blind: IV saline placebo and placebo injection of saline near the femoral nerve were used, and evaluators were unaware of the patients’ treatment group.
At 20 minutes, pain had decreased significantly more with femoral nerve block than with IV fentanyl (median decrease, 4 vs. 2 points on a 10-point pain scale).
Within 4 hours, patients in the nerve-block group were significantly less likely to require rescue analgesia (21% vs. 62%).
Adverse effects (e.g., nausea and dizziness) occurred exclusively in the fentanyl group.
Altunbaş E, et al. Femoral nerve block vs IV fentanyl for hip fracture pain in the emergency department: A randomized double-blind clinical trial. Am J Emerg Med 2026 Jan; 99:359 10.1016/j.ajem.2025.10.044.41167010
Comment
This isn’t the first study to document the advantages of nerve block in patients with hip fracture, but its findings are compelling because of placebo controls and double-blinding. When clinicians with expertise in nerve block are available in a timely fashion — which is increasingly the case for emergency medicine–trained physicians — the procedure should be considered, especially for older patients. Although femoral nerve block was used in this study, other options include fascia-iliaca compartment block and pericapsular nerve group block. Note, however, that this study didn’t address the additional analgesia that might be required if surgery is delayed substantially.