Efficacy and duration of ultrasound guided fascia iliaca block for hip fracture performed in the emergency departments

doi:10.21454/rjaic.7518.242.ber

Cited by 8 publications

(5 citation statements)

References 8 publications

(9 reference statements)

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“…While there were no differences in delirium by FICB status, it was interesting to find that patients who developed delirium were more likely to receive a second block than those who did not develop delirium (18% vs 2%, p=0.002), and delirium was also higher in patients who had block failure than success (18% vs 5%, p=0.06). Our block failure rate of 4.5% was lower than the range of 6%–60% in the literature 17–19…”

Section: Discussioncontrasting

confidence: 60%

A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture

Salottolo

Meinig

Fine

et al. 2022

Trauma Surg Acute Care Open

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ObjectivesUntil recently, systemic opioids have been standard care for acute pain management of geriatric hip fracture; however, opioids increase risk for delirium. Fascia Iliaca compartment blocks (FICB) may be favored to systemic analgesia for reducing delirium, but this has not been well demonstrated. We evaluated the efficacy of adjunctive FICB versus systemic analgesia on delirium incidence, opioid consumption, and pain scores.MethodsThis prospective, observational cohort study was performed in patients (55–90 years) with traumatic hip fracture admitted to five trauma centers within 12 hours of injury, enrolled between January 2019 and November 2020. The primary end point was development of delirium, defined by the Confusion Assessment Method tool, from arrival through 48 hours postoperatively, and analyzed with multivariate Firth logistic regression. Secondary end points were analyzed with analysis of covariance models and included preoperative and postoperative oral morphine equivalents and pain numeric rating scale scores.ResultsThere were 517 patients enrolled, 381 (74%) received FICB and 136 (26%) did not. Delirium incidence was 5.4% (n=28) and was similar for patients receiving FICB versus no FICB (FICB, 5.8% and no FICB, 4.4%; adjusted OR: 1.2 (95% CI 0.5 to 3.0), p=0.65). Opioid requirements were similar for patients receiving FICB and no FICB, preoperatively (p=0.75) and postoperatively (p=0.51). Pain scores were significantly lower with FICB than no FICB, preoperatively (4.2 vs 5.1, p=0.002) and postoperatively (2.9 vs 3.5, p=0.04).ConclusionsFICB demonstrated significant benefit on self-reported pain but without a concomitant reduction in opioid consumption. Regarding delirium incidence, these findings suggest clinical equipoise and the need for a randomized trial.Level of evidenceII—prospective, therapeutic.

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Section: Discussioncontrasting

confidence: 60%

A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture

Salottolo

Meinig

Fine

et al. 2022

Trauma Surg Acute Care Open

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“…Additionally, the duration of analgesia provided by a single-shot FIB is variable, ranging from 8 to 44 hours, and our median time from block placement to surgery was 19.2 hours. 41,42 Moreover, the majority of FIBs used in this study were single-shot blocks (59.8%). If the duration of analgesia provided by a single-shot block was a confounding factor, we would expect to see less difference in preoperative opioid consumption compared with our historical control.…”

Section: Discussionmentioning

confidence: 99%

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients

Garlich

Pujari

Moak

et al. 2020

J American Geriatrics Society

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BACKGROUND Geriatric hip fracture patients are susceptible to the adverse effects of opioid‐induced analgesia. Fascia iliaca blocks (FIBs) have emerged as an analgesic technique for this population. There are limited data on a preoperative FIB's effect on perioperative opioid intake. We hypothesized that preoperative FIB would reduce perioperative opioid consumption, measured in morphine milliequivalents (MMEs). DESIGN This is a prospective observational study. SETTING A level 1 trauma center in California. PARTICIPANTS From March 2017 to December 2017, patients 65 years and older presenting with a hip fracture received a preoperative FIB and were prospectively observed. This cohort was compared with a historical control. INTERVENTION All prospectively enrolled patients were given FIBs. For a single‐shot FIB, a 30‐ to 40‐mL bolus of 0.25% bupivacaine with 1:200,000 epinephrine was injected. For a continuous FIB, a bolus of 10 to 20 mL of 0.2% bupivacaine was injected, followed by a continuous infusion of 0.2% bupivacaine at 6 mL/h ending on the morning of postoperative Day 1. RESULTS A total of 725 patients were included in this study, with 92 in the prospectively collected cohort. The mean age of this cohort was 84.2 (standard deviation = 8.4) years, and 69.2% were female. Patients who received a preoperative FIB consumed less MME preoperatively, 18.0 (interquartile range = 6.0–44.5) versus 29.5 (interquartile range = 6.0–56.5) (P = .007), with no change in pain scores. No differences were found in postoperative opioid consumption between groups. There was no difference in MME or pain score in patients with dementia. Subgroup analysis based on fracture pattern (femoral neck and intertrochanteric) demonstrated a significant decrease in preoperative MME consumption in femoral neck fractures only, 12.0 (interquartile range = 5.0–24.0) versus 29.0 (interquartile range = 12.0–59.0) (P < .001). CONCLUSION FIBs reduce preoperative opioid intake and have low rates of opioid‐related adverse events in geriatric hip fracture patients. LEVEL OF EVIDENCE The level of evidence was II.

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“…This study had several limitations. First, we were unable to record the onset time of analgesia because the patients received the block whilst under the effect of spinal anesthesia, and we were also unable to determine the block duration because we did not observe the patients for more than 24 h. Levente et al [ 34 ] reported that the median duration of a conventional fascia iliaca block with 40 ml of 0.5% ropivacaine is 48 h and can be prolonged by increasing the volume and concentration of the local anesthetic. However, caution is advised to not exceed the limits for local anesthetic systemic toxicity when using high volumes and concentrations [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study

Genc,

Tulgar,

Unal

et al. 2024

Korean J Anesthesiol

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Background: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. Methods: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-anddown sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the midthigh six hours postoperatively. Results: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). Conclusions: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

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Efficacy and duration of ultrasound guided fascia iliaca block for hip fracture performed in the emergency departments

Cited by 8 publications

References 8 publications

A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture

A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients

The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study

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