Use of neurolytic nerve blocks and mortality in nonoperative management of hip fracture patients
The Bone & Joint Journal · 1 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Nonoperative, palliative management of frail hip fracture patients is a growing pathway, and this paper raises the possibility that widely-adopted neurolytic nerve blocks may not extend meaningful survival despite short-term mortality benefits, which matters for end-of-life counselling and hospital policy.
The evidence
This Dutch nationwide registry study looked at 1,415 elderly hip fracture patients (mean age 86) who were managed nonoperatively, comparing the 633 (45%) who received a neurolytic phenol nerve block for pain control with those who did not. Nerve block patients had lower mortality at 7 days (24.9% vs 39.0%) but higher mortality at 90 days (74.9% vs 68.1%) and 180 days (79.7% vs 72.9%), while an adjusted Cox model showed a lower 30-day hazard of death with blocks (adjusted HR 0.73, 95% CI 0.61-0.88, p<0.001); the authors conclude the blocks were not associated with prolonged survival overall.
all-cause mortality: Hazard ratio 0.73 (95% CI 0.61 to 0.88; units not reported). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Retrospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot reported
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If neurolytic nerve blocks reduce early mortality but are linked to higher mortality by three to six months, how should this change what you tell families about expected survival when choosing nonoperative management?
2.Given the wide hospital-to-hospital variation in nerve block use (4% to 100%), how should patient selection criteria for these blocks be standardised in your own practice?
Original publication title
Use of neurolytic nerve blocks and mortality in nonoperative management of hip fracture patients