[Fascia iliaca block performed by emergency department physician trainees in hip fractures]

Abstract

Introduction: Patients with hip fractures (HF) may have severe pain on arrival to the emergency department (ED) and have traditionally been treated with systemic opioids. The aim of this study was to investigate the effect of fascia iliaca compartment block (FICB) performed by ED physician trainees in patients with HF.

Material and methods: This prospective study included 102 patients with femoral neck fractures. After arrival to the ED they received a FICB. The block was performed by ED physician trainees who injected a weight-adjusted amount of 5 mg/ml ropivacaine. Pain intensity at rest was registered immediately before the block (T0) and after one hour (T1) using a visual analogue scale (VAS). Adequate pain relief was defined as VAS </= 3 at rest, at T1.

Results: Pain intensity at rest was VAS 7 (IQR 5-8) and 3 (IQR 2-6) at T0 and T1, respectively (p < 0.001). At T1 32% of the patients had adequate pain relief (VAS </= 3) at rest. Patients with adequate pain relief at T1 had a shorter length of hospital stay compared with other patients: 10.5 (IQR 4-17) versus 13.4 (IQR 7.5-25.7) days, (p < 0.001). There were no differences in incidence of postoperative complications, hospital mortality or 180 day mortality between the groups. There were no local or systemic side effects to the blockades.

Conclusion: FICB performed by the ED trainees is a suitable method for acute pain relief in patients with HF, but only results in adequate pain relief at rest in 1/3 of the patients.