A Cochrane review [Abstract] 1 included 17 studies with a total of 888 subjects (mainly elderly and female) with hip fracture. Nerve blocks (including epidurals) of any types were compared with no nerve block. Nine studies considered a nerve block undertaken at or shortly after admission to hospital and eight studies considered nerve blocks inserted at the time of surgery. Nerve blocks resulted in statistically significant reductions in reported pain levels and in the quantity of parenteral or oral analgesia administered to control pain from the fracture or during surgery. There were few reported complications and no major complications associated with nerve blocks. There was no statistically significant difference in mortality between the groups (RR 0.59, 95% CI 0.29 to 1.21, favouring the nerve block group; 8 studies). Only two of the outcomes assessing different general medical complications reported any statistically significant difference; the risk of pneumonia (RR 0.49, 95% CI 0.26 to 0.94; 5 studies, n=259), and the risk of any cardiac complication (RR 0.25, 95% CI 0.07 to 0.84; 2 studies, n=124) were significantly reduced for those allocated to receive the nerve blocks.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding).
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