Association of Preoperative Continuous Peripheral Nerve Blocks with Early Opioid Requirements and Pain in Older Adults with Hip Fracture: A Retrospective Cohort Study

Jedniphat Intrapongpan,1 Panupong Rattanasrisoy,1 Aumjit Wittayapairoj,1 Naruemon Vattanasiriporn,1 Pattamaporn Chokkatiwat,1 Phaitoon Promchat,2 Nattawadee Phokaw,1 Saranyoo Nonphiaraj,1 Chanapat Charoensuk1 1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Nursing, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Chanapat Charoensuk, Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Tel +6643-363-060, Email [email protected]: To evaluate whether continuous peripheral nerve blocks (PNBs) are independently associated with reduced early opioid consumption and improved pain outcomes in older adults with hip fractures.Methods: Patients aged ≥ 65 years admitted with hip fractures were included in this retrospective cohort study and categorized into a PNB group (continuous fascia iliaca compartment block or continuous femoral nerve block) and a control group without peripheral nerve block. The primary outcome was cumulative fentanyl-equivalent opioid consumption within 24 hours after admission. Secondary outcomes included pain intensity (Numeric Rating Scale [NRS]), postoperative opioid consumption within 24 hours after surgery, delirium, length of hospital stay, and catheter-related complications. Multivariable linear regression adjusted for age, sex, ASA physical status, fracture type, and time to surgery.Results: In total, 203 patients were analyzed (PNB, n = 147; control, n = 56); 36.0% underwent surgery within 48 hours of admission. Opioid consumption within 24 hours after admission was lower in the PNB group (median [IQR]: 50 [0– 90] μg vs 100 [60– 150] μg; p < 0.001). After adjustment, continuous PNB remained independently associated with reduced opioid consumption within 24 hours after admission (adjusted β − 43.8 μg; 95% CI − 59.3 to − 28.3; p < 0.001) and within 24 hours postoperatively (adjusted β − 63.2 μg; 95% CI − 79.7 to − 46.7; p < 0.001). Pain scores improved after block placement and remained lower at 24 hours after admission and postoperatively. Longer time to surgery was independently associated with increased opioid consumption. Delirium, length of stay, and catheter-related complications did not differ significantly between groups.Conclusion: In older adults with hip fractures, continuous peripheral nerve block was independently associated with reduced opioid consumption and improved perioperative pain control, and may support perioperative analgesia in healthcare settings where surgical delay is common.Keywords: hip fracture, continuous peripheral nerve block, fascia iliaca block, femoral nerve block, opioid consumption, regional anesthesia