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#36545 Single shot peripheral nerve blocks with liposomal bupivacaine for fracture neck of femur at preoperative setting: case series of a QI initiative- a dgh experience
  1. Muditha Chathuranganie Mawathage1,
  2. Iqbal Usman2 and
  3. Madan Narayanan3
  1. 1Anaesthesia, Frimley Park Hospital, Surrey, UK
  2. 2Anaesthesia, Frimley Park Hospital, Frimley, UK
  3. 3Anaesthesia, Frimley Park Hospital, FRIMLEY, UK


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Background and Aims Liposomal bupivacaine (LB) may provide analgesia up to 96 hours following single shot injection. Its role in perioperative pain management regimen is still emerging(1). As a part of on-going quality improvement (QI) project, we introduced LB in peripheral nerve blocks (PNBs) for patients who admitted with fracture neck of femur (NOF) requiring extended optimisation prior to surgery. We aimed to audit the place of LB as an alternative to the continuous catheter technique.

Methods Info poster was introduced. Ultrasound-guided PNBs were performed by the regional anaesthetists at ward setting on the request of trauma or acute pain team. We examined the pain scores at rest and on movement, opioid and anti-emetic use, and time until first mobilisation post-operatively over 96h duration.

Abstract #36545 Figure 1

Pain scores at rest and on movement over 96 hours

Results 20 patients received PNB with LB. FICB was performed in 100% along with PENG block in 40%. Pain scores across the first 96 hours post-PNB are displayed in figure 1. During the hospital course, 40% of patients required opioid prior to PNB, and thereafter it had been reduced to 5%, 15%, 0% 15% and 15% in consecutive day 0 to 5. Neither of them were required antiemetics nor limited mobility due to pain on within first 24 hours.

Conclusions PNB with LB may beneficial in vulnerable patients with fracture NOF who may wait beyond the window period for surgery as a part of multimodal analgesia. However, a case series may not enough to demonstrate a reliable outcome and formal clinical trials are needed to establish the true contribution of LB.

Attachment IMG-20230311-WA0005 (1).jpg

  • Liposomal Bupivacaine
  • Fracture neck of femur

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