Local Infiltrative Analgesia is Equivalent to Fascia Iliaca Block for Perioperative Pain Management for Prophylactic Cephalomedullary Nail Fixation

BackgroundImpending pathologic fractures of the femur due to metastatic bone disease are treated with prophylactic internal fixation to prevent fracture, maintain independence, and improve quality of life. There is limited data to support an optimal perioperative pain regimen.MethodsA proof of concept comparative cohort analysis was performed: 21 patients who received a preoperative fascia iliacus nerve block (FIB) were analyzed retrospectively while 9 patients treated with local infiltrative analgesia (LIA) were analyzed prospectively. Primary outcomes included: visual analog scale (VAS) pain scores, narcotic requirements and hospital length of stay. Patient cohorts were compared via two-sample t-tests and Fischer’s exact tests. Differences in VAS pain scores, length of stay and morphine milligram equivalents (MME) were assessed with Wilcoxon rank sum.ResultsThe LIA group had more patients treated with preoperative narcotics (p=0.042). There were no significant differences between the FIB and LIA groups in MME utilized intraoperatively (30.0 vs 37.5, p=0.79), on POD 0 (38.0 vs 30.0, p=0.93), POD 1 (46.0 vs 55.5, p=0.95) or POD 2 (40.0 vs 60.0 p=0.73). There were no significant differences in analog pain scale at any time point or in hospital length of stay (78 vs 102 hours, p=0.86).ConclusionDespite an increased number of patients being on preoperative narcotics in the LIA group, use of LIA compared with FIB is not associated with an increase in VAS pain scores, morphine milligram equivalents (MME), or length of hospital stay in patients undergoing prophylactic internal fixation of impending pathologic femur fractures.Level of Evidence: III