Ultrasound-Guided Fascia Iliaca Compartment Block for Hip Fractures in the Emergency Department

Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
Journal of Emergency Medicine (Impact Factor: 0.97). 04/2012; 43(4):692-7. DOI: 10.1016/j.jemermed.2012.01.050
Source: PubMed


Hip fracture (HFx) is a painful injury that is commonly seen in the emergency department (ED). Patients who experience pain from HFx are often treated with intravenous opiates, which may cause deleterious side effects, particularly in elderly patients. An alternative to systemic opioid analgesia involves peripheral nerve blockade. This approach may be ideally suited for the ED environment, where one injection could control pain for many hours.
We hypothesized that an ultrasound-guided fascia iliaca compartment block (UFIB) would provide analgesia for patients presenting to the ED with pain from HFx and that this procedure could be performed safely by emergency physicians (EP) after a brief training.
In this prospective, observational, feasibility study, a convenience sample of 20 cognitively intact patients with isolated HFx had a UFIB performed. Numerical pain scores, vital signs, and side effects were recorded before and after administration of the UFIB at pre-determined time points for 8h.
All patients reported decreased pain after the nerve block, with a 76% reduction in mean pain score at 120min. There were no procedural complications.
In this small group of ED patients, UFIB provided excellent analgesia without complications and may be a useful adjunct to systemic pain control for HFx.

Download full-text


Available from: L. Haines, Sep 15, 2014
  • Source
    • "Recently ultrasonography has also been used for the performance of this nerve block [18,19]. However, because of the high costs for the ultrasound equipment, it is expected that this technique will not be widely applied in the prehospital setting, although the use of ultrasound certainly has benefits over the blind technique. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with a proximal femur fracture are often difficult to evacuate from the accident scene. Prehospital pain management for this vulnerable group of patients may be challenging. Multiple co-morbidities, polypharmacy and increased age may limit the choice of suitable analgesics. The fascia iliaca compartment (FIC) block may be an alternative to intravenous analgesics. However this peripheral nerve block is mainly applied by physicians. In the Netherlands, prehospital emergency care is mostly provided by EMS-nurses. Therefore we examined whether well-trained EMS-nurses are able to successfully perform a FIC block in order to ensure timely and appropriate effective analgesia. The study was study was registered in the Netherlands Trial Register (NTR-nr 3824). Ten EMS nurses were educated in the performance of a FIC-block. Indications, technique, side-effects and complications were discussed. Hereafter the trained EMS-nurses staffed ambulance teams were dispatched to patients with a suspicion for a proximal femur fracture. After confirmation of the diagnosis, the block was performed and 0.3 ml/kg lidocaine (10 mg/ml) with adrenaline 5 μg/ml was injected. The quality of pain relief, occurrence of complications and patient satisfaction were evaluated. In 108 patients a block was performed. One hundred patients could be included. Every EMS nurse performed at least 10 FIC blocks. The block was effective in 96 patients. The initial median (NRS)-pain score decreased after block performance to a score of 6 (after 10 minutes), 4 (after 20 minutes) and 3 (after 30 minutes). At arrival at the Emergency Department the median pain score was 3. Dynamic NRS-pain scores when transferring the patient from the accident scene to the ambulance stretcher, during transportation to the hospital and when transferring the patient to a hospital bed were, 4, 3 and 3.5 respectively. Patient satisfaction was very high. No complications were noted. Additional educated EMS-nurses are able to successfully perform a FIC-block for providing acute pain relief to patients with a suspected proximal femur fracture.
    Full-text · Article · Jun 2014 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
  • Source
    • "A non-randomized study of fascia iliaca block by Emergency Department physicians found adequate block at 1 hour in only 30% of subjects, although improvements in outcome (length of stay) were favorable in those with a successful block [12]. Use of ultrasound would be expected to improve the success rate of regional techniques and evidence does support this [14]. A recent trial comparing ultrasound-guided femoral nerve block to parenteral opioids in an Emergency Department setting in exactly this patient group demonstrated significantly reduced pain scores and decreased the need for rescue analgesia [15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Hip fractures are very painful leading to lengthy hospital stays. Conventional methods of treating pain are limited. Non-steroidal anti-inflammatories are relatively contraindicated and opioids have significant side effects.Regional anaesthesia holds promise but results from these techniques are inconsistent. Trials to date have been inconclusive with regard to which blocks to use and for how long. Interpatient variability remains a problem. Methods/Design This is a single centre study conducted at Queen’s Medical Centre, Nottingham; a large regional trauma centre in England. It is a pragmatic, parallel arm, randomized controlled trial. Sample size will be 150 participants (75 in each group). Randomization will be web-based, using computer generated concealed tables (service provided by Nottingham University Clinical Trials Unit). There is no blinding. Intervention will be a femoral nerve block (0.5 mls/kg 0.25% levo-bupivacaine) followed by ropivacaine (0.2% 5 ml/hr−1) infused via a femoral nerve catheter until 48 hours post-surgery. The control group will receive standard care. Participants will be aged over 70 years, cognitively intact (abbreviated mental score of seven or more), able to provide informed consent, and admitted directly through the Emergency Department from their place of residence. Primary outcomes will be cumulative ambulation score (from day 1 to 3 postoperatively) and cumulative dynamic pain scores (day 1 to 3 postoperatively). Secondary outcomes will be cumulative dynamic pain score preoperatively, cumulative side effects, cumulative calorific and protein intake, EUROQOL EQ-5D score, length of stay, and rehabilitation outcome (measured by mobility score). Discussion Many studies have shown the effectiveness of regional blockade in neck of femur fractures, but the techniques used have varied. This study aims to identify whether early and continuous femoral nerve block can be effective in relieving pain and enhancing mobilization.Trial registration. Trial registration The trial is registered with the European clinical trials database Eudract ref: 2010-023871-25. (17/02/2011). ISRCTN: ISRCTN92946117. Registered 26 October 2012.
    Full-text · Article · May 2014 · Trials
  • Source
    • "The second general area of investigation would include both assessment of the potential clinical uses already mentioned, and perhaps study of other areas for which TEMS US could be useful. These additional areas, including for instance skull fracture diagnosis [44, 45] and guidance of prehospital nerve blocks [46, 47], may have limited application in tactical medicine, but they appear worth consideration. Furthermore, it is likely that as TEMS operators begin to use US more, further unforeseen indications and applications may be identified (as occurred when US was introduced into the ED setting). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The term "tactical medicine" can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years' literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.
    Full-text · Article · Nov 2012
Show more