Peripheral nerve block use in elderly adults remains low

Although the use peripheral nerve blocks have increased over time, it remains underutilized for pain control in elderly adults after hip fracture, with a receipt rate of <5 percent in hospitalized patients, a recent study has found.

Accessing claims data from a private US insurer, the researchers conducted a retrospective cohort study of 94,985 elderly patients admitted for femoral neck, subtrochanteric and intertrochanteric fractures. The receipt of a peripheral nerve block was the main measurement, and potential predictors were also examined.

Rates of peripheral nerve block use increased over time, from 0.4 percent in 2004–2006 to 4.6 percent in 2013–2016. The absolute change value was significant (95 percent confidence interval [CI], 4.4–4.8; p<0.001), though the final rate of receipt remained low. A total of 2,992 nerve block claims were listed, of which 71.1 percent were femoral nerve blocks.

Logistic regression analysis confirmed the increase in use rates over time (2013–2016 vs 2004–2006: odds ratio [OR], 1.22, 95 percent CI, 1.20–1.24; p<0.001).

On the other hand, older patients were less likely to be given nerve blocks (75–84 vs <65 years: OR, 0.86, 95 percent CI, 0.74–1.00; p=0.02; ≥85 vs <65: OR, 0.88, 95 percent CI, 0.75–1.04; p=0.16). The same was true for having a history of dementia (OR, 0.88, 95 percent CI, 0.80–0.98; p=0.02).

Medical comorbidities, except for a history of drug abuse (OR, 1.27, 1.01–1.60; p=0.04), were all unrelated to the likelihood of being given peripheral nerve blocks.