Abstract
Background
Fascia iliaca compartment block (FICB) has become a keystone technique for acute pain
management in patients with hip and proximal femur fractures.
Objectives
To demonstrate that administering FICB preoperatively to patients with hip or proximal
femur fractures in the emergency department (ED) is likely to reduce opioid use and
related complications, and to decrease hospital length of stay (LOS).
Methods
An unblinded study of adult patients with hip and proximal femur fractures who consented
to receive an FICB with 30 cc of bupivacaine with epinephrine administered in the
ED. We compared this group with a contemporaneous group of controls who only received
systemic opioids. Over the course of approximately 6 months, main outcome measured
between the two groups was amount of morphine equivalents given from block administration
until 8 h after. We also compared complications such as delirium, constipation, and
bleeding rates (oozing from injection site or hematoma formation).
Results
A total of 166 patients with hip and proximal femur fractures from August 12, 2018
to April 25, 2021; 81 received FICB plus systemic opioids, and 85 received only systemic
opioids. Among the FICB group, morphine equivalents were reduced by 0.6 mg/h with
no significant difference in LOS. A statistically significant difference in opioid-related
adverse outcomes was found between the anticoagulated group vs. the no anticoagulation
group.
Conclusions
FICB is a safe and effective preoperative technique for initial pain management in
patients with hip and proximal femur fractures, as it can also be used with additional
systemic opioids. FICB administration may reduce systemic opioid use preoperatively,
thus reducing opioid-related adverse effects with no significant impact on hospital
LOS.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Current challenges in pain management in hip fracture patients.J Orthop Trauma. 2016; 30 (suppl): S1-S5
- Fascia iliaca block for pain control in hip fracture patients [El bloqueo iliofascial en el tratamiento analgésico de la fractura de cadera del anciano].Rev Esp Cir Ortop Traumatol. 2017; 61 ([in English, Spanish]): 383-389
- Fascia iliaca block in the emergency department for hip fracture: a randomized, controlled, double-blind trial.BMC Geriatr. 2019; 19: 180
- Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures.Am J Emerg Med. 2010; 28: 76-81
- Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus.Can J Anaesth. 2019; 66: 1356-1384
Centers for Disease Control and Prevention (CDC). Hip fractures among older adults. Available at: https://www.cdc.gov/falls/hip-fractures.html. Accessed Xxxx XX, 202X .
- Relationship between pain and opioid analgesics on the development of delirium following hip fracture.J Gerontol A Biol Sci Med Sci. 2003; 58: 76-81
National Library of Medicine, National Center for Biotechnology Information. Compound summary: bupivacaine. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/Bupivacaine-hydrochloride. Accessed Xxxx XX, 202X.
- Fascia iliaca regional anesthesia in hip fracture patients revisited: which fractures and surgical procedures benefit most?.J Orthop Trauma. 2020; 34: 469-475
- A comparison in outcomes of preoperative single-shot versus continuous catheter fascia iliaca regional anesthesia in geriatric hip fracture patients.Injury. 2020; 51: 1337-1342
- Monograph.Relias Media: Emergency Medicine Reports, 2018 (March 1Available at:) (Accessed Xxxx XX, 202X)
- Proximal femur fractures in patients taking anticoagulants.EFORT Open Rev. 2020; 5 (May, 23, 2022): 699-706
Article info
Publication history
Published online: April 29, 2022
Accepted:
April 23,
2022
Received in revised form:
April 10,
2022
Received:
January 10,
2022
Footnotes
Institution where this study was performed: Marshfield Medical Center, Marshfield, Wisconsin. Over the course of the study, the hospital changed names. It was previously known as Ministry Saint Joseph's Hospital.
Identification
Copyright
© 2022 Published by Elsevier Inc.
