Grant: Project Grant

Over 20,000 older Canadians break their hips yearly, a painful occurrence that usually requires surgery. Older people who have a hip fracture are also at high risk of bad health outcomes. Over 20% of older people with a hip fracture have a serious complication, many do not regain the full ability to walk after surgery, and 25% die within six months. This means that we need to develop ways to make hip fracture care safer. Because hip fractures cause a lot of pain, strong painkillers (like morphine and other opioid drugs) are often needed. But these drugs can have serious side effects, like breathing problems, memory loss and delirium. Unfortunately, if hip fracture pain isn't treated, patients can also suffer issues with their ability to walk and move, their memory function, and other serious complications. So, finding ways to effectively manage hip fracture pain without strong opioid medications could lead to less pain and lower rates of bad health outcomes. Research suggests that using nerve blocks, where local anesthetic (aka freezing) medication is injected near the pain nerves that supply the fracture, can improve pain and decrease complications. While these improvements sound promising, recent reports also tell of a person dying after a nerve block because the health system wasn't properly set up to care for the nerve block in a high-risk hip fracture patient. This means that before nerve blocks are widely used for hip fracture pain, we should do research to understand their safety profile and how the health system can best-support safely giving these nerve blocks. To help to understand the safety profile of nerve blocks, we propose a study to: (1) define how often complications arise directly related to nerve blocks, (2) to determine how the health system could be best prepared to safely provide nerve blocks, and (3) to see if using nerve blocks leads to an overall increase or decrease in complications during hip fracture hospital stays.