Hip Fractures Sustained Through Inpatient Falls Are Associated With Lower Rates of Fascia Iliaca Block Administration and Higher Opiate Requirements: A Single-Centre Experience

Background Hip fractures, also known as neck of femur (NOF) fractures, are a major cause of morbidity in older adults. Effective pain control is essential to minimise opioid-related complications such as delirium. Fascia iliaca blocks (FIBs) provide regional anaesthesia that can reduce opioid requirements. While emergency department (ED) pathways routinely include FIBs for NOF patients, it is unclear whether those who sustain NOFs during inpatient admissions receive comparable care. Methods A retrospective case-control study was conducted at a single NHS major trauma centre between January 2019 and December 2020. Patients aged over 60 with radiologically confirmed NOFs sustained during an inpatient stay were compared with age-, sex-, American Society of Anesthesiologists (ASA) grade-, premorbid mobility-, and Abbreviated Mental Test Score (AMTS)-matched controls admitted via the ED, irrespective of FIB status. Primary outcomes were administration of a FIB and 24-hour opioid use (oral morphine equivalent dose). Secondary outcomes were postoperative delirium, postoperative length of stay, and all-cause mortality at 30 days and one year. Results Of 4026 inpatient falls, 36 resulted in NOFs (3% of all NOFs during the study period (36/1182)). Only 17% (6/36) of inpatients received a FIB compared with 86% (988/1146) of ED-admitted patients (P