A Continuous Infusion Fascia Iliaca Compartment Block in Hip Fracture Patients: A Pilot Study

Abstract

BackgroundHip fractures account for 350,000 fractures annually and the projected incidence is expected to exceed 6.3 million by 2050. As the number of hip fractures continues to increase as a result of the aging American population, the importance of limiting and preventing complications is magnified.MethodsThis study demonstrated the clinical effects of a continuous fascia iliaca compartment block placed pre-operatively when combined with a comprehensive pain protocol. All patients who presented to our institution with a hip fracture were given the option of having a continuous fascia iliaca compartment block for pain control versus usual pain management (non-opioids, opioids, and ice therapy). The block was monitored by the pain service until the day of discharge from the hospital. Data was collected regarding mean pain scores, average length of stay and opioid medication use.ResultsThere were eighteen males and twenty four females. The pain score on post-operative day zero was reduced from a 2010 annual average of 4.1 to 1.7 in the pilot study group on the visual analog score. On post-operative day one, the 2010 annual average was 2.9 compared to 1.4 in the pilot study group. The length of stay was decreased from the 2010 annual average of 5.9 days to 4.8 days in the pilot study group. The patients used an average of 18mg of morphine equivalent medications during the average infusion time of 40.7 hours. There were no falls or infections noted within our pilot study group.ConclusionsOverall, it has been noticed that the reduction in opioid usage in this elderly patient population, with an average age of seventy five years, has produced alert and mobile patients often as early as post-operative day one. The length of stay has decreased along with the average pain score in the pilot sample of forty two patients.KeywordsHip fracture; Fascia Iliaca Compartment Block; Pain Score

Ultrasound‑guided continuous fascia iliaca compartment block for pre‑operative pain control in very elderly patients with hip fracture: A randomized controlled trial

“…In addition, CFICB was associated with greater patient satisfaction, which was consistent with the results of Candal-Couto et al (23) and Dulaney-Cripe et al (24). Diakomi et al (31) concluded that performing an FICB prior to positioning for spinal anesthesia provided superior pain management compared with intravenous fentanyl administration facilitated spinal performance.…”

Continuous Femoral Nerve Block Versus Fascia Iliaca Compartment Block as Postoperative Analgesia in Patients with Hip Fracture

“…One hour after surgery 76.67% of patients from FNB versus 73.33% from FIC group were without pain at rest, and after 2 hours, 60% of patients from both groups (p > 0.05). Most of the patients felt moderate pain 12 hours after surgery at rest, 40.0% from the FNB group versus 43.33% from the FIC group, and a moderate to severe pain was felt by 23 There was a significant difference in pain intensity between patients from the two groups at rest as well as during passive hip flexion up to 24, 36 and 48 hours after surgical intervention (p < 0.001). At these time intervals, a much larger number of patients from the FNB group were registered without pain in comparison to respondents from the FIC group (at rest 43.33% in FNB vs 16 Table 2 presents the first time when the patients in the two groups requested additional analgesia.…”

“…It is performed by application of a great amount of local anaesthetic beneath the fascia iliaca and provides a block of n. femoralis and n. cutaneus femoris lateralis and rarely of n. obturatorius [20,21]. It is a very simple procedure to perform this block; there are almost no complications and hence this procedure belongs to the small group of blocks that need no nerve stimulator or ultrasound [22][23][24]. Although it is simpler in comparison to femoral nerve block, the authors who have experience in performing peripheral block consider it a second choice [25].…”

Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty

“…Dulaney-Cripe et al [26] reported that 42 patients undergoing THA were subjected to the modified FICB under ultrasonographic guidance using 60 mL of 0.5% ropivacaine and infused continuously with 0.2% ropivacaine at the rate of 10 mL/h for postoperative analgesia. This modified FICB technique for the proximal spreading of local anesthetics decreased the postoperative pain score and hospital stay.…”

“…This modified FICB technique for the proximal spreading of local anesthetics decreased the postoperative pain score and hospital stay. [26] Moreover, in another randomized study, the modified FICB using 40 mL of a local anesthetic resulted in the proximal spread of the local anesthetic and decreased the morphine consumption at 12 and 24 hours. [10] Additionally, Kumar et al [11] compared the analgesic efficacy of a suprainguinal approach (modified FICB) and an infrainguinal approach (traditional FICB) for postoperative analgesia.…”