Fascia iliaca block for pain relief from proximal femoral fracture in the emergency department: a review of the literature

Chesters, Adam; Atkinson, Paul

doi:10.1136/emermed-2013-203073

Cited by 37 publications

(15 citation statements)

References 10 publications

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“…Chesters and Atkinson recently published a systematic review of the efficacy of FICB (Chesters and Atkinson, 2014), but their review only considered 2 randomised control trial papers. One of these, by Foss et al (2007), is described as a 'placebo controlled trial'.…”

Section: Resultsmentioning

confidence: 98%

Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: A review of the literature

Pinson

2015

International Emergency Nursing

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Section: Resultsmentioning

confidence: 98%

Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: A review of the literature

Pinson

2015

International Emergency Nursing

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“…With growing evidence that this is a safe, quick and easy to insert block , FIBs are gaining popularity and becoming widely used for peri‐operative pain relief in acute hip fracture, as seen by the increasing use of FIBs in the literature over the last decade . The FIB has been found to be comparable in effectiveness to older blocks such as the ‘3‐in‐1’ femoral nerve block , with now sufficient evidence to support that FIB can provide superior or equal pain relief to other forms of acute analgesia .…”

Section: Methodsmentioning

confidence: 95%

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

et al. 2017

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Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly. There is consistent evidence that regional nerve blocks can effectively reduce pain associated with hip fracture, providing rapid-onset, site-specific analgesia that is more effective than standard systemic analgesia alone. There is also moderate evidence that nerve blocks may contribute to reduced rates of delirium, and some suggestion of reduced length of inpatient stay, morbidity and mortality, although limited evidence is available. Fascia iliaca blocks are emerging as a block of choice, with evidence they can be safely and rapidly administered under ultrasound guidance in the acute setting, by both trained medical and nursing staff, with good effect. Ideally, comprehensive pain protocols for elderly hip fracture patients are required, that integrate evidence-based fascia iliaca block use, timely and repeated pain assessment, and multidisciplinary orthogeriatric patient care.

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“…The use of local anesthetic nerve block has been recommended by the UK National Institute of Health and Care Excellence as part of an opioid sparing strategy. [26] Currently, FNB versus FIB in reducing opioids consumption remains controversial. Newman et al [27] reported that patients with femoral neck fracture receiving a FNB required less morphine after the block than those receiving fascia iliaca compartment block.…”

Section: Discussionmentioning

confidence: 99%

Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty

et al. 2017

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Background:This meta-analysis aimed to perform a meta-analysis to compare the efficiency and safety between femoral nerve block (FNB) and fascia iliaca block (FIB) for postoperative pain control in patients undergoing total knee and hip arthroplasties.Methods:A systematic search was performed in Medline (1966-2017.05), PubMed (1966-2017.05), Embase (1980-2017.05), ScienceDirect (1985-2017.05) and the Cochrane Library. Inclusion criteria (1) Participants: Only published articles enrolling adult participants that with a diagnosis of end-stage of osteoarthritis and prepared for unilateral TKA or THA; (2) Interventions: The intervention group received FIB for postoperative pain management; (3) Comparisons: The control group was received FNB for postoperative pain control; (4) Outcomes: Visual analogue scale (VAS) scores in different periods, opioids consumption, length of stay and postoperative complications; (5) Study design: clinical randomized control trials (RCTs) were regarded as eligible in our study. Cochrane Hand book for Systematic Reviews of Interventions was used for assessment of the included studies and risk of bias was shown. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed. Meta-analysis was performed using Stata 11.0 software.Results:Five RCTs including 308 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = −0.080, 95% CI: −0.306 to 0.145, P = .485), 24 hours (SMD = 0.098, 95% CI: −0.127 to 0.323, P = .393), and 48 hours (SMD = −0.001, 95% CI: −0.227 to 0.225, P = .993). No significant differences were found regarding opioid consumption at 12 hours (SMD = 0.026, 95% CI: −0.224 to 0.275, P = .840), 24 hours (SMD = 0.037, 95% CI: −0.212 to 0.286, P = .771), and 48 hours (SMD = −0.016, 95% CI: −0.265 to 0.233, P = .900). In addition, no significant increase of complications was identified between groups.Conclusion:There is no significant differences of VAS scores at 12-48 hour and opioids consumption at 12-48 hour between two groups following total joint arthroplasty. No increased risk of nausea, vomiting and pruritus was observed in both groups. More high-quality large RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of FNB with FIB. The present meta-analysis exists some limitations that should be noted: (1) Only five articles were included in present meta-analysis, although all of them are recently published RCTs, the sample size are relatively small; (2) Functional outcome is an important parameter, due to the insufficiency of relevant data, we cannot perform a meta-analysis. (3) Dose and types of local anesthetics are varied, which may influence the results; (4) The duration of follow up is relatively short which leads to underestimating complications. (5) Publication bias in present meta-analysis ...

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Fascia iliaca block for pain relief from proximal femoral fracture in the emergency department: a review of the literature

Abstract: the fascia iliaca block could have an important role in first-line pain control for patients presenting to the emergency department with a proximal femoral fracture. There is potential to reform the acute management of this common group of patients.

Cited by 37 publications

References 10 publications

Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: A review of the literature

Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: A review of the literature

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty

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