Fascia Iliaca Block in Hip and Femur Fractures to Reduce Opioid Use

Jain, Nirpeksh; Kotulski, Charles; Al-Hilli, Ali; Yeung‐Lai‐Wah, Paul; Pluta, Joanna; Heegeman, David

doi:10.1016/j.jemermed.2022.04.018

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…ED or preoperative opioid consumption following a FI block had only previously been studied in patients with proximal femur or hip fractures. 17,18,20,24 Wathen et al 25 studied pediatric patients with proximal, diaphyseal, and distal femur fractures and reported significantly less opioid consumption in the ED and preoperatively. A smaller difference in postoperative MME opioid consumption in patients who received a FI block was found.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Fascia Iliaca Blocks Associated with Decreased Opioid Consumption in Femoral Shaft and Distal Femur Fractures

Kolodychuk,

Dubé,

DiNicola

2024

Journal of Orthopaedic Trauma

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Objectives: To examine the impact of fascia iliaca (FI) blocks performed in the emergency department on femoral shaft and distal femur fracture patients on opioid consumption, length of stay, and readmission rate. Methods: Design: Prospective cohort study Setting: Community-based level 1 trauma center Patient Selection Criteria: Patients with isolated low energy femoral shaft or distal femur fractures (OTA/AO 32 and 33) presenting from January 1, 2020 to May 31, 2022 were included. Outcome Measures and Comparisons: Opioid consumption, length of stay, discharge disposition, and 30-day readmission rate were compared between patients undergoing fascia iliaca compartment block and not receiving the block. Results: 136 patients were included. Twenty-four received fascia iliaca block. Both cohorts were primarily female gender 66.7% and 66.9%, respectively for the FI block and no FI block cohort. The majority of the FI block cohort (62.5%) had femoral shaft fractures, while the no FI block cohort had mostly distal femur fractures (56.2%). Mean body mass index, fracture type, and surgical procedure were similar between patients undergoing FI block and not receiving FI block The FI block group had significantly lower opioid consumption pre-operatively (36.1 vs 55.3 morphine milliequivalents (MMEs), p=0.030), post-operatively (71.7 vs 130.6 MMEs, p=0.041), over total hospital stay (107.9 vs 185.9 MMEs), and mean opioid consumption per day of hospital stay (25.9 vs 48.4 MMEs, p=0.003). There was no significant difference in length of stay (4.9 vs 5.0 days, p=0.900), discharge disposition destination (p=0.200), or 30 day readmissions (12.5% vs 4.5%, p=0.148) between groups. Conclusions: Undergoing fascia iliaca block in the emergency department was associated with decreased opioid consumption in patients with femoral shaft or distal femur fractures. There was no associated difference in length of stay, discharge disposition, or 30-day readmissions. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Preoperative Fascia Iliaca Blocks Associated with Decreased Opioid Consumption in Femoral Shaft and Distal Femur Fractures

Kolodychuk,

Dubé,

DiNicola

2024

Journal of Orthopaedic Trauma

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“…Widespread evidence supports the use of PNBs over systemic analgesia for hip fractures. Due to its superior analgesic effect, PNBs reduce the need for systemic opioid use and diminish the pain on movement within 30 minutes 14,15 . This may obviate the use of skin traction as an analgesic technique, which in addition can cause complications such as skin tears and is therefore deemed obsolete16-19.…”

Section: Introductionmentioning

confidence: 99%

Clinical guideline for the use of peripheral nerve block in hip fractures at the emergency department in Belgium

Proesmans,

Vermeylen,

Olyslaegers

et al. 2024

Acta Anaest Belg

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Peripheral nerve blocks (PNBs) for hip fractures are standard of care in many countries at the emergency department and sometimes even in the prehospital setting. This type of analgesic care is however not standard in Belgium. The structural implementation of PNBs at the emergency department depends on the availability of personnel trained in regional anesthesia and a correct informed consent. Given the professionalization of emergency medicine in Belgium since 2005, anesthesiologists have become less involved in most emergency departments. This might cause a potential lack of personnel trained in regional anesthesia. In this article the authors propose a practical guideline with a decision tree to guide better analgesic care for patients with hip fractures in Belgium.

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