Fascia iliaca block, for fractured femur, in Emergency Departments

Abstract

Fractured neck of femur (NOF) is a serious consequence of falls among the elderly population. It is projected that in the United Kingdom alone the incidence of fractured NOF will rise from the current figures of 70,000 per year to 91,500 by 2015 and to 101,000 in 2020. About 10% of people with hip fracture die within 1 month. However, fewer than half of the deaths are directly attributable to the fracture. The high prevalence of co morbidity in this group presents major challenges in the patient’s pre and post-operative care. Studies that have looked at the delivery of analgesia in the emergency department (ED) have consistently shown that delayed and sub-therapeutic pain relief remains a problem. Objective: To determine the effect of fascia iliaca block, on pain relief, in patients with fractured femur (neck, shaft). Method: We did the literature search and found 11 papers to be relevant to our question. Results: We had 3 RCTs and 8 prospective cohort studies. There were total 930 patients and pain relief was assessed between 15 min to 24 h. They also assessed the need for further analgesia (morphine). They were conducted in theatres and EDs. Total 804 patients were tested for FIB in all studies. The RCTS showed significant pain relief, in patients with FIB, up to 180 min (p = 0.01). Discussion: We have traditionally been using opiates for severe pain but they don’t come without side effects, especially the elderly group takes most of the blow. As discussed above, NOF fracture makes a significant number of patients presenting to ED. Therefore having a non-opiates based pain relief like FIB, makes it very useful. The above papers suggest a beneficial role of ultrasound guided FIB in femoral fractures either as an alternative or adjunct to the routinely used analgesia. Evidence suggests that the placement of local anaesthetic in the wrong plane will reduce the success of any regional anaesthetic technique. The use of ultrasound guidance will permit the identification of the fascia iliaca and neurovascular bundle. It will also provide help in the needle guidance and direct observation of local anaesthetic spread in real time. Therefore the chances of effective block are extremely high when done under ultrasound guidance.