Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture

Abstract

This study investigate the efficacy of pre-operative pain treatment for patients with hip fractures using fascia lliaca compartment block (FIB) technique performed by junior registrars (JR) as a supplement to conventional pain treatment. The FIB technique has routinely been used pre-operatively in the emergency department since 1 January 2004 for all patients with hip fractures. Over an 8-month period, 187 patients were treated. FIB was performed with 40 ml lidocaine and bubivacaine. A simple 5-step verbal pain score and maximal passive hip flexion was used as objective and subjective pain measurements. Effect of FIB was prospectively assessed on 70 patients: 2/3 females, mean age 80.7 (SD = 7.8), 36% in ASA-group III and IV (95% CI, 0.25-0.48). The median pain-free hip flexion pre-block was 15 degrees (SD = 17) this improved to a median of 28 degrees (SD = 21) 15 min post-block (P = 0.014) and 37 degrees (SD = 26) 60 min post-block (P = 0.030). The median simple verbal pain score (0-4) pre-block was 2.2 (SD = 0.92). This decreased to a median of 1.5 (SD = 0.78) 15 min post-block (P < 0.001) and 1.3 (SD = 0.71) 60 min post-block (P = 0.021). No side-effects were observed. There was no correlation between the number of FIB previously performed by the attending registrar and the improved maximal hip flexion (rho = 0.090, P = 0.50) or reduction in subjective pain score (rho = 0.005, P = 0.971). FIB performed by JR is a feasible, efficient pre-operative supplement to conventional pain-treatment for patients with hip fractures. FIB is easy to perform, requires minimal introduction, no expensive equipment and is connected with a minimal risk approach.

Fig. 1

Puncture site

Fig. 2

Anatomy of fascia iliaca compartment. 1 fascia lata, 2 fascia iliaca, 3 N. femoralis, 4 N. cutaneus femoris lateralis, 5 V. og A. femoralis, 6 M. pectinale, 7 M. psoas

Fig. 3

Simple 5-step subjective verbal pain score before and after fascia iliaca compartment block application. 1, before block; 2, 15 min after block; 3, 60 min after block

Fig. 4

Maximal pain-free hip flexion before and after fascia iliaca compartment block application. 1, before block; 2, 15 min after block; 3, 60 min after block

Fig. 5

Correlation between improved maximal hip flexion after fascia iliaca compartment block (FIB) application and the number of FIB previously performed. Scale for numbers of FIB previously performed by the treating doctors. 0, 0; 1, 1–4; 2, 5–9; 3, ≥10