Single Fascia Iliaca Compartment Block is Safe and Effective for Emergency Pain Relief in Hip-fracture Patients

Leonieke Groot, Lea M Dijksman, Maarten P Simons, Mariska M S Zwartsenburg, Jasper R Rebel, Leonieke Groot, Lea M Dijksman, Maarten P Simons, Mariska M S Zwartsenburg, Jasper R Rebel

Abstract

Introduction: Currently, it is common practice in the emergency department (ED) for pain relief in hip-fracture patients to administer pain medication, commonly systemic opioids. However, with these pain medications come a high risk of side effects, especially in elderly patients. This study investigated the safety profile and success rate of fascia iliaca compartment block (FICB) in a busy ED. This ED was staffed with emergency physicians (EPs) and residents of varying levels of experience. This study followed patients' pain levels at various hourly intervals up to eight hours post procedure.

Methods: Between September 2012 and July 2013, we performed a prospective pilot study on hip-fracture patients who were admitted to the ED of a teaching hospital in the Netherlands. These patients were followed and evaluated post FICB for pain relief. Secondary outcome was the use of opioids as rescue medication.

Results: Of the 43 patients in this study, patients overall experienced less pain after the FICB (p=0.04). This reduction in pain was studied in conjunction with the use and non-use of opioids. A clinically meaningful decrease in pain was achieved after 30 minutes in 62% of patients (54% with the use of opioids, 8% without opioids); after 240 minutes in 82% of patients (18% with opioids, 64% without opioids); after 480 minutes in 88% of patients (16% with opioids, 72% without opioids). No adverse events were reported.

Conclusion: In a busy Dutch ED with rotating residents of varying levels of experience, FICB seems to be an efficient, safe and practical method for pain reduction in patients with a hip fracture. Even without the use of opioids, pain reduction was achieved in 64% of patients after four hours and in 72% of patients after eight hours.

Figures

Figure 1
Figure 1
Flowchart showing hip-fracture patients included and excluded from study-analysis. INR, international normalized ratio; ED, emergency department
Figure 2
Figure 2
Boxplots showing overall reduction in pain (NRS) during admission (in time). NRS, numeric rating scale
Figure 3
Figure 3
Percentage of patients with a clinically relevant reduction in pain. All values are reported in number (%). Time period is minutes after block placement. Missing values were respectively: 6, 8, 9, 15, 18, which means: numbers of documented pain scores at time 30 minutes were for 37 patients; after 60 minutes for 35 patients; after 120 minutes for 34 patients, after 240 minutes for 28 patients and 480 minutes after block placement pain scores are documented for 25 patients. Clinically relevant reduction in pain was reached when patient’s level of pain was lowered by ≥35% when the initial NRS was between 6–8 (moderate pain). For patients with severe pain (NRS≥8) a decrease of ≥45% was regarded as clinically meaningful. NRS, numeric rating scale

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Source: PubMed

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