Local anesthetic use for hip fracture patients on the day of admission is increasing, data suggests

Patients with traumatic injuries who are treated in the emergency room are susceptible to opioid-related adverse drug effects. Increased use of regional anesthesia can be helpful in the effort to reduce the use of opioids. However, it's not clear how often patients receive regional anesthesia prior to going to the operating room. Additionally, local anesthesia agents, which are used for regional anesthesia, carry their own risks for which anesthesiologists need to be prepared. For these reasons, researchers at the Hospital for Special Surgery set out to estimate how frequently regional anesthesia is used in the pre-surgical setting.

The team analyzed hip fracture patients from the Premier Healthcare database, a large database that has electronic health records from more than 1,000 hospitals. They found that the number of hip fracture patients receiving ultrasound-guided regional anesthesia with bupivacaine increased from 13.3% to 18.6% from 2009-2019, and the number of patients receiving ropivacaine increased from 2.0% to 9.4%. Of 864,416 patients admitted to the hospital for hip fracture, only 1,126 (0.11%) underwent surgery on the day of hospital presentation, suggesting that most of the local anesthesia use was before surgery.

Dr. Alexander Stone, MD, received one of three Resident/Fellow Travel Awards from the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) for the project. He will present the abstract "Injected Local Anesthetic Use for Hip Fracture Patients on the Day of Hospital Presentation: A National Database Analysis" on Friday, April 1, at 10:15 am during the 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting being held March 31-April 2, 2022, in Las Vegas, NV. Coauthors include Drs Haoyan Zhong, Jashvant Poeran, Jiabin Liu, and Stavros Memtsoudis.

Our data suggests that local anesthetic use on the day of admission is increasing, especially for long-acting local anesthetics. This could be in part due to an increase in regional anesthetics being used in the emergency department, though we were not able to measure that directly using our database."

Dr Alexander Stone, American Society of Regional Anesthesia and Pain Medicine

Dr. Stone noted that patients being treated with long-acting local anesthetics prior to surgery may be at risk for local anesthetic toxicity.

"We are working on a follow along study, a survey made possible by ASRA Pain Medicine, to better understand who is preforming nerve blocks in emergency departments are and how often they are being performed by anesthesiologists," Stone said.

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