Introduction Femoral neck fractures are a common and painful injury. Femoral nerve blocks, and a variant of this technique termed the '3-in-1' block, are often used in this patient group, but their effect is variable. The fascia iliaca compartment block (FIB) has been proposed as an alternative, but the relative effectiveness of the two techniques in the early stages of care is unknown. We therefore compared the FIB versus the 3-in-1 block in a randomised trial conducted in two UK emergency departments. Methods Parallel, two-group randomised equivalence trial. Consenting patients >18 years with a femoral neck fracture were randomly allocated to receive either a FIB or a 3-in-1 block. The primary outcome was pain measured on a 100 mm visual analogue scale at 60 min. The between-group difference was adjusted for centre, age, sex, fracture type, pre-block analgesia and pre-block pain score. Results 178 patients were randomised and 162 included in the primary analysis. The mean 100 mm visual analogue pain scale score at 60 min was 38 mm in the FIB arm and 35 mm in the 3-in-1 arm. The adjusted difference between the arms was 3 mm, with a 95% CI (−4.7 to 10.8) that excluded a clinically important difference between the two interventions. Conclusions FIB is equivalent to the 3-in-1 block for immediate pain relief in adult neck of femur fractures. Trial registration number ISRCTN16152419.

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Objectives: Illegal drug use is common in emergency department (ED) patients, but previous prevalence studies have relied upon approaches that may underestimate the true extent of the problem. The aim of this study was to examine illegal drug use in a typical adult ED. Methods: We employed an independent researcher to prospectively and anonymously interview patients attending an inner city adult ED throughout all 168 hours of a typical week. Additional information collected from the treating clinician indicated whether each presentation was directly or indirectly related to illegal drug use. Results: We found that 6.9% of all patient attendances were directly or indirectly related to illegal drug use, and hospital admission was required in nearly half of these. The majority of drug related problems were acute injuries, overdose, and the medical complications of drug use. Conclusions: This suggests that the emergency healthcare burden related to illegal drug use is substantial, and higher than previously reported. I llegal drug use is common. The British Crime Survey 2000, a representative household survey of 13 300 people, found that 34% of people aged 16-59 years had used illegal drugs at some time, and 6% in the previous month. Health problems related to illegal drugs use are well recognised, but are difficult to quantify, as social circumstances make drug users difficult to identify and engage in research. In emergency care, studies of the prevalence of illegal drug use have relied on data collected by treating healthcare professionals, or retrospective review of the clinical notes.2-4 These methods may lead to bias and under-reporting.Our study used an independent researcher to prospectively measure the proportion of illegal drug users among all patients attending an inner city emergency department (ED), and quantified the emergency healthcare burden represented by this patient group. METHODSThe study was approved by Weston local research ethics committee. An independent researcher approached all adult patients attending our inner city ED, and with their consent, completed a confidential semi-structured survey. Patients were excluded if they had a life threatening illness, chronic mental impairment, were unable to understand/give verbal consent, or did not speak English. A technique of representative sampling was used, so that patients were recruited throughout all 168 hours of a typical week. Patients were anonymised, and responses were not shared with clinical staff. The researcher subsequently interviewed the treating doctor regarding the patient's diagnosis, need for admission, and whether they considered the attendance to be directly, indirectly, or not related to illegal drug use. Data were analysed using descriptive statistics and frequencies. RESULTSThe results are summarised in fig 1. The mean age was 40.4 years (range 16-98). Of the patients interviewed, 290 (36.2%) had used illegal drugs in their lifetime (lifetime drug users), 129 (16.1%) in the previous month, and 79 (9.9%) within the previous 2...

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