Summary of findings 1. Peripheral nerve blocks for hip fracture.
| Peripheral nerve blocks for hip fracture | ||||||
| Patient or population: patients with hip fracture Settings: for outcomes included in this table, studies were conducted in Argentina (N = 1), Canada (N = 1), Chile (N = 1), China (N = 4), Denmark (N = 1), France (N = 2), Germany (N = 1), Greece (N = 2), Ireland (N = 1), Japan (N = 1), Korea (N = 1), Nepal (N = 1), South Africa (N = 1), Spain (N = 2), Sweden (N = 2), Switzerland (N=1), Turkey (N = 2), United Kingdom (N = 5), and United States of America (N = 2) Intervention: peripheral nerve blocks Comparison: no block | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Systemic analgesia | Peripheral nerve blocks | |||||
| Pain on movement at 30 minutes after block placement Follow‐up: 20 to 45 minutes | Mean pain on movement at 30 minutes after block placement in the intervention groups was 1.05 standard deviations lower (1.25 to 0.86 lower) | 503 (11 studies) | ⊕⊕⊕⊕ higha,b | |||
|
Acute confusional state Follow‐up: 0 to 30 days |
Study population | RR 0.67 (0.50 to 0.90) | 1072 (13 studies) | ⊕⊕⊕⊕ higha,c | ||
| 181 per 1000 | 121 per 1000 (90 to 163) | |||||
| Low | ||||||
| 150 per 1000 | 101 per 1000 (75 to 135) | |||||
| High | ||||||
| 350 per 1000 | 235 per 1000 (175 to 315) | |||||
|
Myocardial infarction Follow‐up: 0 to 30 days |
N/A | N/A | 31 (1 study) | ⊕⊕⊝⊝ lowd | ||
|
Chest infections Follow‐up: 0 to 30 days |
Study population | RR 0.41 (0.19 to 0.89) | 131 (3 studies) | ⊕⊕⊕⊝ moderatee,f | ||
| 269 per 1000 | 110 per 1000 (51 to 239) | |||||
| Low | ||||||
| 50 per 1000 | 20 per 1000 (9 to 44) | |||||
| High | ||||||
| 200 per 1000 | 82 per 1000 (38 to 178) | |||||
| Death Follow‐up: 0 to 6 months | Study population | RR 0.87 (0.47 to 1.60) | 617 (11 studies) | ⊕⊕⊝⊝ lowd | ||
| 68 per 1000 | 59 per 1000 (32 to 109) | |||||
| Low | ||||||
| 25 per 1000 | 22 per 1000 (12 to 40) | |||||
| High | ||||||
| 150 per 1000 | 131 per 1000 (70 to 240) | |||||
|
Time to first mobilization Follow‐up: in‐hospital |
Mean time to first mobilization in intervention groups was 10.80 hours lower (12.83 to 8.77 lower) | 208 (3 studies) | ⊕⊕⊕⊝ moderatee | |||
|
Cost of analgesic regimens for single‐injection blocks Follow‐up: in‐hospital |
Mean cost of analgesic regimens for single‐injection blocks in intervention groups was 4.40 euros lower (4.84 to 3.96 lower) | 75 (1 study) | ⊕⊕⊕⊝ moderated,g | |||
| The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; N/A: not applicable; RR: risk ratio. | ||||||
| GRADE Working Group grades for certainty of evidence. High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||||
aThe effect was still present even when trials at high risk of bias were withdrawn from the analysis, or when a correction for the possibility of publication bias was applied.
bThe difference was equivalent to 2.5 on a scale from 0 to 10.
cThe number needed to treat for additional beneficial outcome was 12 (95% confidence interval 7 to 47).
dDowngraded by two levels for imprecision.
eDowngraded by one level for imprecision.
fThe number needed to treat for additional beneficial outcome was 7 (95% confidence interval 5 to 72).
gMean costs in 2009 euros.