Journal of Bone Research
Open Access

In the case of a femoral neck fracture, a femoral nerve block is used (FINOF)

Enrico Fasolato^{* *}Correspondence: Enrico Fasolato, Editorial office, Journal of Bone Research, Spain, Email:

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Editorial

Hip fractures are incredibly painful and may necessitate extended hospital stays. In the traditional sense, pain management options are limited. Opioids have negative side effects, and nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently contraindicated. Trials have so far proven inconclusive as to which blocks should be employed and for how long. Variability between patients is still a concern. Hip fractures are still one of the most dangerous injuries for the elderly, with a death rate of 10% after one month, 20% after four months, and 30% after a year. Many people who recover lose their independence and mobility. About half of patients who were formerly functionally independent become partially reliant, while a third become completely dependent.

Both before and after surgery, hip fractures are excruciatingly painful. Adequate pain management is not only a humanitarian issue; it can also hinder rehabilitation. Pain is connected to a larger neurohormonal stress response, heart ischemia, and delayed mobility, all of which can lengthen hospital stays and increase the chance of death. Opioids provide enough analgesia when used at rest, however they are ineffective when used to treat dynamic pain. Patients commonly report moderate to severe pain during physiotherapy and ambulation while feeling OK at rest, which is an issue after surgery. Adverse effects from opioids are common, unpleasant, and sometimes lethal. Typical adverse effects include nausea, vomiting, constipation, and stomach emptying. The less common but more serious adverse effects include delirium, respiratory depression, and death. Regional anaesthesia is a feasible alternative to systemic opioids both before and after surgery. Delirium has also been linked to pain that has gone untreated. Analgesia is now provided with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), oral or parenteral opioids, and localised anaesthetic methods. Although paracetamol is an efficient and safe analgesic when administered alone, it is insufficient for a significant number of individuals.

The less common but more serious adverse effects include delirium, respiratory depression, and death. Regional anaesthesia is a feasible alternative to systemic opioids both before and after surgery. Delirium has also been linked to pain that has gone untreated. Analgesia is now provided with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), oral or parenteral opioids, and localised anaesthetic methods. Although paracetamol is an efficient and safe analgesic when administered alone, it is insufficient for a significant number of individuals.

• The primary goal of this research is to see if early femoral nerve blockade, followed by the insertion of a femoral nerve catheter and a local anaesthetic infusion, results in an increase in cumulative mobility and a decrease in cumulative dynamic pain in the first three days after femur fracture surgery.

• A secondary goal is to see if using a femoral nerve block early reduces cumulative pain (in the first 180 minutes of admission), cumulative side effects (nausea, vomiting, constipation, and delirium) in the first three days after surgery, reduces overall length of stay, improves calorific and protein intake, and improves health-related quality of life.

The key objectives will be cumulative ambulation scores (from day 1 to day 3 postoperatively) and cumulative dynamic pain scores (day 1 to 3 postoperatively). Preoperatively, secondary outcomes will include the cumulative dynamic pain score, cumulative side effects, cumulative calorific and protein intake, EUROQOL EQ-5D score, length of stay, and rehabilitation outcome (measured by mobility score). The widespread adoption and usage of ultrasound guidance in regional anaesthesia has demonstrated that block effectiveness can be enhanced and that these blocks may be placed quickly.