Implementation of the fascia iliaca block in the emergency department for patients with hip fractures
Hip fractures, proximal femoral fractures, fascia iliaca block, nerve block
Published online: May 16 2024
Abstract
Background: Hip fractures are a common pathology with high morbidity and mortality. Proper pain management is a challenge in this elderly population. Evidence suggests benefit of the use of a fascia iliaca block (FIB) in the emergency setting.
Objectives: The aim is to develop, implement and evaluate a protocol for the application of FIB in the emergency department for patients with hip fractures at the University Hospital of Antwerp. Additionally, a survey was conducted on analgesia policies for hip fractures in hospitals in Flanders.
Methods: A protocol was created for the implementation of FIB in the emergency department. Training was provided for anesthesiologists and emergency nurses on ultrasound-guided supra-inguinal FIB. To evaluate the implementation of the protocol an observational cohort study was conducted. A survey was created on the use and protocols of pain management for hip fractures. It was emailed to all hospitals in Flanders.
Results: From 01/06/2022 to 31/01/2023, 46 patients were included. FIB was not applied in 36.9% of these patients. There were no significant differences in age, BMI, and gender between the groups with or without FIB (p>0.05). No toxicities were registered. There were no significant differences in pain scores upon admission or after intervention between the groups with and without FIB (p=0.5). The median number of points the pain score decreased was 1.5 points in both groups, with no significant difference (p=0.4). The survey revealed that locoregional techniques are used in about two-thirds of cases of hip fractures, with various techniques applied. They are usually performed by an anesthesiologist.
Conclusions: The protocol was usually correctly applied, an audit could identify areas for improvement of its application. The safety of the technique was confirmed. Further investigation is needed to provide evidence for the benefit of the application of an FIB in the emergency department in this population.
