Ultrasound-Guided Fascia Iliaca Compartment Block

Excerpt

Pain management is an integral part of providing care in the emergency setting. Lower extremity pain from hip fractures, burns, and other trauma is a common presenting complaint. Pain management can be complex due to medication side effects, patient preferences, and other patient characteristics that can make intravenous analgesia less desirable. Opioid medications can be associated with respiratory depression, hypotension, mental status changes, and vomiting. Non-steroidal anti-inflammatory drugs (NSAIDs) can increase bleeding risk and exacerbate underlying gastrointestinal (GI) problems. Acetaminophen alone is often not sufficient for severe pain. Hip fractures, in particular, can cause considerable pain and frequently occur in elderly adults with multiple comorbidities, which makes analgesia challenging.

A fascia iliaca compartment block can provide superior analgesia with minimal side effects. This block can be deployed quickly after a small amount of training and can be executed with high success rates under ultrasound guidance. In a study by Monzon et al, patients who received a fascia iliaca compartment block for a hip fracture had significantly reduced pain levels. The pain was initially rated at an average of 8.5 on a 10-point scale but decreased to an average of 2.3 at 2 hours postinjection. In a study by Stevens et al, patients who underwent a fascia iliaca compartment block used significantly less morphine over 24 hours than the control group, which used morphine alone. An additional advantage is the duration of effect, which has been seen for 8 to 10 hours following a single shot block. Another randomized placebo-controlled trial showed that pain relief was superior at all time points measured in the fascia iliac compartment block group as compared with a group utilizing morphine only. Median total morphine consumption in the compartment block group was 0 mg due to excellent analgesia after only a compartment block. Similar results were seen in a study by Lopez et al for femoral shaft fractures. Emergency department-specific studies using ultrasound guidance have shown 76% mean reduction of pain score in patients with hip fractures at 120 minutes.

Notably, some physicians now prefer to use a pericapsular nerve group (PENG) block over the fascia iliaca block technique. Some studies suggest that the PENG technique provides superior pain control. Either method provides an important opiate sparing alternative for pain management in these patients.