Chemical neurolysis for the conservative treatment of hip fractures

Abstract

Aim: Hip fracture management is challenging when surgical risks outweigh benefits. Inadequate analgesia from conservative treatments prompted new procedures targeting hip capsule denervation. This study evaluates the efficacy and safety of single injection chemical hip neurolysis in the pericapsular nerve group plane. Materials & methods: In eligible patients, an ultrasound-guided diagnostic block was performed using 5 ml of 2% lidocaine in the pericapsular nerve group plane. If positive, 6 ml of 99.9% alcohol was administered. Results: From May 2022 to May 2023, five patients underwent hip neurolysis. None reported pain at day 5 or during follow-up. There were no adverse effects. Conclusion: Chemical neurolysis seems to provide effective and safe conservative treatment for hip fractures, offering reliable analgesia for nonsurgical candidates.

Plain language summary

Managing hip fractures is difficult, especially when surgery is too risky. Traditional pain relief methods often do not work well enough, so doctors are exploring new ways to reduce pain by targeting the nerves around the hip.

In this study, we looked at a new technique called chemical neurolysis to see if it can safely and effectively relieve pain for people with hip fractures who can not have surgery.

For this procedure, doctors first used a special technique to find the right spot near the hip using ultrasound. Then, they injected a small amount of a numbing medicine called lidocaine to see if it helped with the pain. If it did, they followed up by injecting alcohol to block the pain nerves more permanently.

Between May 2022 and May 2023, five patients received this treatment. All of them reported no pain 5 days after the procedure and there were no negative side effects. We continued to check on them regularly to monitor their progress.

In conclusion, chemical neurolysis appears to be a safe and effective way to manage hip fracture pain for patients who cannot undergo surgery, providing reliable pain relief without major risks.

Article highlights

• Conservative treatment options for hip fractures often provide insufficient analgesia.

• Chemical neurolysis offers a safe and effective conservative treatment option for hip fractures in nonsurgical candidates.

• A multidisciplinary approach involving orthopedic and anesthesiology teams enhances patient care and selection for neurolysis.

• In our retrospective case series, chemical hip neurolysis was achieved with a single ultrasound-guided injection of absolute alcohol in the pericapsular nerve group plane after a positive diagnostic block.

• Targeting only the pericapsular nerve group plane with a single needle approach expedites identification of landmarks and simplifies the technique, enhancing reproducibility.

• All patients who underwent the procedure were pain free and able to tolerate the sitting position and hygiene care during the follow-up period and no adverse effects were reported.

• Future research directions include conducting large prospective studies to assess the efficacy and safety of this approach, as well as investigating the potential benefits of injecting neurolytic agents directly at the fracture site or intracapsular to the hip joint for enhanced pain relief.

Keywords: :

• alcohol
• conservative treatment
• hip fracture
• neurolysis

Author contributions

All authors contributed equally to the manuscript.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materialsdiscussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No funded writing assistance was used in the creation of this manuscript.

Ethical conduct of research

All patients provided written informed consent for the procedure and inclusion in this study, except for one patient. For this patient, the legal guardian provided written consent due to the patient’s cognitive impairment from dementia, which rendered the patient incapable of understanding the risks and benefits of the procedure. The hospital’s legal department is involved in these matters to ensure compliance with local laws.