Temporal Trends in the Use of Regional Anesthesia for Hip Fracture Surgery: A Retrospective Single-Center Study

Cureus · 2025-06-24

INTRODUCTION: Hip fractures are associated with significant morbidity and mortality in the United States. Over the past decade, considerable research has been directed toward identifying the optimal anesthetic and analgesic techniques for hip fracture surgery. It was hypothesized that regional anesthesia (neuraxial anesthesia and peripheral nerve blocks) may improve outcomes by avoiding the risks of general anesthesia and providing opioid-sparing analgesia in these complex patients. For neuraxial anesthesia, evidence of clinical benefit has been inconsistent in the literature; however, studies on peripheral nerve block analgesia have shown more consistent advantages. It is unclear if this data has influenced changes in clinical practice. MATERIALS AND METHODS: We conducted a retrospective single-center study of patients who underwent hip fracture surgery at the University of Virginia Medical Center from 2018 to 2022. Descriptive statistics were produced for patient demographics and clinical characteristics, and generalized linear regression models were used to examine trends in anesthetic techniques (general versus neuraxial anesthesia and use of peripheral nerve blocks) over time. We also examined the association between regional anesthesia and patient outcomes, including hospital length of stay (primary outcome), postoperative pain scores, incidence of acute kidney injury and myocardial injury, and discharge disposition (secondary outcomes), as well as diurnal variation in regional anesthesia utilization. RESULTS: We observed a 30% increase in the number of neuraxial anesthesia cases per year (from 10% (n = 12) of patients in 2018 to 33% (n = 40) in 2022), as well as an increase in peripheral nerve block utilization over time (1.7% (n = 2) of patients in 2018 to 28.1% (n = 34) in 2022). Neuraxial anesthesia was associated with a 17.1% lower hospital length of stay compared to general anesthesia (primary outcome, mean 6.2 vs 7.4 days, p = 0.006). There were no other differences in postoperative outcomes, and there was no evidence of diurnal variation in regional anesthesia utilization. CONCLUSIONS: The increase in peripheral nerve block utilization demonstrates continued progress in quality of care, while emphasizing that there is still significant room for improvement. A larger multicenter database study will be helpful to assess if the evolving literature has influenced broader changes in clinical practice.

Updates in Regional Anesthesia and Acute Pain Medicine: Bridging the Gap Between Evidence and Clinical Practice

Anesthesiology Clinics · 2025-08-18

‘Pain as regional anaesthesia wears off’ or ‘rebound pain’: what's in a name?

Anaesthesia · 2025-03-03 · 8 citations

Rates of delirium by age group among surgical and non-surgical patients receiving low-dose ketamine infusion

Regional Anesthesia & Pain Medicine · 2025-09-16 · 1 citations

New Kids on the Block: Development and Assessment of a Multispecialty Fascia Iliaca Block Protocol and Training Program for Geriatric Hip Fracture in the Emergency Department

Cureus · 2025-03-14

Background Hip fracture is a common presentation to emergency departments. Opioid-based medications are often used for analgesia but are associated with increased morbidity and mortality. Regional anesthesia for hip fractures can improve pain and other outcomes with minimal risk. The adoption of this procedure in the emergency department and perioperative space is low due to a lack of training and inadequate buy-in from consultants. Methods The Departments of Emergency Medicine, Anesthesiology, Orthopedic Surgery, Pharmacy, and Nursing collaborated to develop a multispecialty ultrasound-guided infrainguinal fascia iliaca block (FIB) protocol and training program at a large, urban, Level 1 trauma center. Training for emergency medicine physicians consisted of a one-half-hour lecture teaching the FIB technique, recognition and treatment of local anesthetic systemic toxicity (LAST), where to find the necessary equipment, and how to utilize the FIB order set and procedure note template in the electronic medical record. Learners then participated in a one-half-hour simulation session using a high-fidelity, inexpensive, do-it-yourself model. To assess the participants' perceived knowledge and comfort with the FIB, we administered a survey to participants immediately before and after the training sessions. Results Prior to training, 4% (n = 48) of emergency medicine (EM) participants reported that they knew how to perform the block, and 2% felt comfortable doing so. After training, 100% of the participants reported knowing how to perform the block, and 92% felt confident performing the procedure. From March 2022 to June 2023, 37 FI blocks were performed in the emergency department (ED), representing 15% of the 249 hip fractures presenting to the ED during this time. Prior to the intervention, EM providers were not performing the block. Conclusion The utilization of nerve blocks in our geriatric hip fracture population increased dramatically and persistently with the institution of this protocol.

Applications of Big Data in Perioperative Outcomes Research and Evidence-Based Clinical Practice

Anesthesiology Clinics · 2025-10-01

2026 American Society of Anesthesiologists Practice Guideline on Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries

Anesthesiology · 2025-12-09 · 12 citations

This practice guideline addresses perioperative pain management using local and regional anesthesia for cardiothoracic, mastectomy, and abdominal surgery in adults and children. For adults, the American Society of Anesthesiologists (Schaumburg, Illinois) Task Force on Perioperative Pain Management strongly recommends fascial plane blocks to reduce pain and/or opioid requirements in the first 24 h postoperatively for open cardiothoracic, abdominal, retroperitoneal, and pelvic surgeries and mastectomy. Fascial plane blocks are also recommended in adults to reduce pain and/or opioid requirements after minimally invasive abdominal procedures. The Task Force conditionally recommends use of fascial plane blocks for minimally invasive cardiothoracic surgeries and open hernia repair to reduce pain in the first 24 h postoperatively. For children, the Task Force strongly recommends use of fascial plane blocks to reduce pain/and or opioid use after open cardiac or thoracic surgeries. Fascial plane blocks are conditionally recommended to reduce pain the first 24 h in children undergoing open hernia repair. Overall, data analysis for this practice guideline was limited by low methodologic quality, inconsistencies in outcome measurements, and small sample sizes from individual centers. Future research in regional anesthesia and analgesia needs to address these pervasive limitations.

Unlocking the Potential of Big Data and Artificial Intelligence in Regional Anesthesiology and Acute Pain Medicine

Anesthesiology Clinics · 2025-10-01 · 1 citations

Prioritization of outcome measures in regional anesthesia research

Regional Anesthesia & Pain Medicine · 2025-10-28 · 1 citations

BACKGROUND: Outcome selection in regional anesthesia and acute pain research is inconsistent, often lacking patient-centered priorities and validated instruments. We aimed to prioritize key outcomes and propose suitable measurement tools to improve the quality, consistency, and relevance of regional anesthesia research. METHODS: We conducted a multiround Delphi process, including two electronic voting rounds, a multiday in-person meeting, and a patient panel. Experts and patients evaluated existing and proposed outcomes for importance, validity, and relevance. Outcomes reaching ≥70% agreement were prioritized, and appropriate measurement instruments were identified. RESULTS: Thirty-two experts and three patients participated. Across three Delphi rounds, 10 outcomes were prioritized for future regional anesthesia research: seven efficacy outcomes (pain scores; opioid consumption; Brief Pain Inventory; functional outcomes; cognitive function; length of stay; block duration); two multidimensional outcomes (quality of recovery and development of a regional anesthesia-specific quality-of-recovery instrument); one safety outcome (chronic postsurgical pain). Patients prioritized cognitive recovery, function, chronic pain, and pain scores. CONCLUSIONS: This consensus-based, patient-centered framework defines the core priorities for future regional anesthesia and acute pain research. Future work should focus on developing and validating a regional anesthesia-specific quality-of-recovery instrument, refining multidimensional measures such as functional recovery, cognitive outcomes, and the Brief Pain Inventory, and standardizing the reporting of chronic pain and opioid-related outcomes. Adoption of these priorities will enhance methodological consistency, comparability, and patient relevance in future clinical trials.

Building an Inclusive Practice Within Regional Anesthesia and Acute Pain Medicine

Anesthesiology Clinics · 2025-09-25