• M I Segado Jiménez, M Bayón Gago, J Arias Delgado, M L Casas García, F Domínguez Hervella, A López Pérez, and C Izquierdo Gutiérrez.
• Servicio de Anestesiología, Reanimación y Tratamiento del Dolor y de Farmacia Hospitalaria, Complejo Hospitalario de Ourense. misj1980@hotmail.com
• Rev Esp Anestesiol Reanim. 2009 Dec 1;56(10):590-7.

ObjectivesThe treatment of pain after surgery to repair a hip fracture is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Our aim was to compare the efficacy of obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation, and cost.Patients And MethodsProspective study of 75 patients undergoing surgery to repair hip fractures. Patients were randomized to receive intravenous analgesia only, blockade of both nerves, or blockade of only the obturator nerve. In each group we recorded visual analog scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs.ResultsAnalgesia was significantly more effective in patients with nerve blocks than in those who received only intravenous analgesia (mean [SD] VAS scores, 2.6 [1.4] and 5.6 [0.7], respectively). Patients with nerve blocks also had a pain-free period of more than 24 hours (P < .001), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (P < .01), started rehabilitation earlier (32.6 [5.4] hours vs 45.7 [8.2] hours), generated less expenditure (2.6 Euros [1.5 Euros]/patient vs 7.0 Euros [0.4 Euros]/patient). The tested techniques had no complications.ConclusionsThe nerve blocks were effective, easy to perform, and safe. They afforded numerous advantages: extended period of postoperative analgesia, fast recovery, lower costs, and no complications.

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