The Bone & Joint Journal · IF 4.6 · August 1, 2026 · LoE III
Use of neurolytic nerve blocks and mortality in nonoperative management of hip fracture patients
Hanne-Eva van Bremen, Marte Inge Lommerse, Johannes H. Hegeman, Henk Jan Schuijt, Jan Willem Kallewaard, Hugo H Wijnen, Lotta J Seppala, Nathalie van der Velde, Hanna C. Willems — Dutch Institute for Clinical Auditing
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.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersNonoperative, 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 counseling and hospital policy.
Conclusion strengthInconclusive
Retrospective cohort: cannot support a practice change on its own.
Presenting this at rounds? Start here
- ?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?
- ?Given the wide hospital-to-hospital variation in nerve block use (4% to 100%), how should patient selection criteria for these blocks be standardized in your own practice?