Virtual Conference

Rajul Patel

Waitemata DHB, New Zealand

Title: Hip Ultrasound Guided Haematoma (HUSH) block for intrascapsular neck of femur fractures outperforms fascia-iliaca block


Regional anaesthesia has become integral to best practice analgesia in patients with neck of femur fractures (NOFFs). These are generally elderly and frail and are particularly vulnerable to side effects of oral and parenteral opioid analgesia. We present a novel technique, using point of care ultrasound guidance to perform hip ultrasound guided haematoma (HUSH) aspiration, and injection of local anaesthetic (block) for intracapsular neck of femur fractures. This is performed by an Orthopaedic surgeon in the emergency department or on the ward. his a case control series. With informed consent a consecutive series of cognitively intact patients, with an isolated intra-capsular NOFF, received a HUSH block using 10mls of 0.75% Ropivicaine. The procedure was performed by a Surgeon. This was performed in addition to standard NOFF care pathway analgesia that includes a FIB and multimodal analgesia including opioids for breakthrough pain. Visual Analogue Scale (VAS) pain scores at rest and on movement were recorded pre and five minutes post procedure, and then at two hourly intervals. There were 10 patients that met criteria and consented to HUSH block and 39 patients included in our control series. In the HUSH block group a mean pain score of 9/10 prior to block and 1.5/10 in the time after the block was found with a mean total morphine equivalent use of 8.75mg. This is significantly different from the control groups mean VAS pain score 6.9 (p=0.0001) with a mean total morphine equivalent use of 24.1mg (p=0.07) . Hip Ultrasound Guided Haematoma (HUSH) Block in addition to fascia iliaca block appears to significantly better pain relief in intracapsular neck of femur fracture patients when compared to fascia iliaca block alone. The procedure is particularly effective if haematoma is aspirated. We believe it is relatively easy to perform with readily available ultrasound scanners in emergency departments.


Rajul Patel, is a junior Orthopaedics doctor based in Waikato Hospital, New Zealand. He has a keen interest in General Orthopeadics and optimizing patient care and outcomes.