Fascia iliaca block for pain control in hip fracture patients

Castillón, Pablo; Veloso, Margarita; Gómez, Oscar; Salvador, J.; Bartra, Agustí; Angles, Francesc

doi:10.1016/j.recote.2017.10.005

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…Up until now, various methods have been used for both preoperative and postoperative pain management. [12] In the preoperative period, intravenous administration of non-steroid drugs and opioids [13,14] and performing nerve blocks [15,16] have been frequently used for pain control. However, pain after femur fracture may not arise solely from the hip joint.…”

Section: Discussionmentioning

confidence: 99%

“…Some previous studies reported that the fascia iliaca block could provide effective analgesia after femur fracture in the elderly. [16,17] Moreover, Kassam et al [18] found the fascia iliaca block to provide a morphine-sparing effect in the preoperative period. In the present study, we aimed to apply an intermittent nerve block (instead of a single-shot block) by placing a nerve catheter; therefore, we preferred to perform FNB and provided bet- Preop delirium score 3.52±3.12 1.75±2.14 ter pain control than paracetamol did.…”

Section: Discussionmentioning

confidence: 99%

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The effect of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: a randomized controlled trial

Uysal

Altıparmak

Yaşar

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Hip fracture is a common clinical problem which causes severe pain in geriatric patients. However, severe pain following fracture may bring on mental disorders and delirium. A neuroinflammatory response with IL-6 and IL-8 has been shown to be associated with the pathophysiology of delirium. In this study, our primary hypothesis is that preoperative femoral nerve block (FNB) intervention in geriatric patients will more effectively attenuate pain following trochanteric femur fracture than the preoperative paracetamol application. Our secondary hypothesis is that interleukin levels (IL-6, IL-8) in cerebrospinal fluid (CSF) will be lower in the femoral nerve block group than the paracetamol group. Our tertiary hypothesis is that the incidence of postoperative delirium will be lower in the femoral nerve block group. METHODS: The patients over 65 years of age with ASA status II-IV and admitted to the Emergency Service for femur fracture were included in this study. Recommendations of the "delirium prevention table" were applied to all of the patients at arrival. In the first group, 15 mg/kg paracetamol was administered intravenously every eight hours. In the second group, femoral nerve blockage was performed, and a catheter was placed. Then, 0.5 mL/kg bupivacaine 0.25% was applied every eight hours. In both groups, pain scores four hours after interventions were recorded. All patients were operated within 48 hours under spinal anesthesia. During spinal anesthesia, 2 mL of CSF samples were taken from all patients for analysis of IL-6 and IL-8 cytokines, and pain scores during positioning were recorded. RESULTS: VAS scores four hours after the first preoperative pain treatment and during the positioning for regional anesthesia were significantly lower in the femoral nerve block group. IL-8 levels are significantly lower in the femoral nerve block group but not in IL-6 levels. The incidence of delirium was less in the femoral nerve block group, but the difference was not statistically significant. CONCLUSION: The femoral nerve block was more effective in preoperative pain management of trochanteric femur fracture and preventing pain during regional anesthesia application. The mean IL-8 level was lower in the femoral nerve block group when compared to the paracetamol group. There is no difference in the postoperative delirium incidence between groups.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: a randomized controlled trial

Uysal

Altıparmak

Yaşar

et al. 2019

Ulus Travma Acil Cerrahi Derg

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“…In addition, early mobility and reduced post-operative stay were possible. 5 In a RCT involving 48 hip surgeries Fascia iliaca compartment block vs. IM morphine FICB administered preoperative provided ease of administration of SA and effective postoperative operative pain control. 6,7 Foss N et al used FICB for acute pain control in hip fracture and found oral morphine requirement of 48.5 vs. 31.5 in SA group compared to FICB group.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study on the Effects of Pre-Operative Fascia Iliaca Plane Block on Hip Surgeries Done Under Spinal Anaesthesia in Elderly Patients, vs. No Block on Post Operative Pain Scores

Pillai¹

2018

jebmh

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BACKGROUND Hip surgery is one of the common surgeries performed in orthopaedics. It is mainly done in elderly population as they are more prone to fractures, due to osteoporotic bone and tendency to fall. Pain reduction is a major concern in this group due to advanced age and associated comorbid conditions. In addition to patient suffering, pain leads to increased hospital stay and morbidity due to delirium. Effort has been made to reduce pain by giving opioids, NSAIDS, long acting intrathecal opioids, epidurals and recently using nerve blocks especially using ultrasound. Several blocks have been tried like femoral nerve block, three in one block, fascia iliaca block and sciatic block. The advantage of intraoperative block is the continuation of effect in post-operative period, less requirement of opioids and early mobilization, less delirium and overall less initial mortality. Here we tried to study the effect of intraoperative 35% ropivacaine and dexmedetomidine 50 micrograms given as FICB. MATERIALS AND METHODS 50 elderly patients with only hip fracture admitted between 2017 to 2018, above 60 years of age, were subjected to the study. Patients included those who consented to procedure under spinal anaesthesia. They were explained about the procedure, the willingness for block, the risk factors involved and taught about VAS scale for pain assessment. Inclusion Criteria-Elderly patients above 60 years of age, male/female, hip surgery alone, cases done under spinal with 5% bupivacaine. Exclusion Criteria-Patients with contraindications for block like coagulopathy-including drug induced, infection at site, inguinal hernia, poor mentation, stroke, patient refusal, allergy to any of the drug component, patient with bradycardia with heart rate less than 60. RESULTS The patients who were given preoperative blocks were having analgesia for over 8 hours to 18.3 hours. They had a satisfactory VAS score of less than 3 up to 24 hr with paracetamol and rescue doses of tramadol. CONCLUSION FICB is effective fascial plane block for post-operative hip pain. It reduces the post-operative stay. Mixing dexmedetomidine increases the total duration by 18-24.3 hrs. with minimum hemodynamic instability and sedation.

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“…Because previous studies on this subject are limited, sample size calculation was performed based on reports using similar therapeutic methodologies [2,[5][6][7][8]. We assumed that the response rates of IFI with and without visual feedback are 65% and 40%, respectively.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…Ultrasound-guided interfascial injection (IFI) has recently been receiving increased attention as a therapy for treating MPS [7,8]. In ultrasound-guided IFI, doctors use ultrasound to inject a drug solution into the interfascial space (including subcutaneous tissue, epimysial space, the space between the periosteum and fascia, and the periphery of tendon) at the site where patients feel the most severe pain.…”

Section: Introductionmentioning

confidence: 99%

Effect of Visual Feedback During Ultrasound-Guided Interfascial Injection for Myofascial Pain Syndrome: A Prospective, Multicenter, Observational Clinical Trial

Hasuo

Oomori

Yoshida³

et al. 2021

Preprint

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Background: Expectations for treatment have a favorable effect on the subsequent course of pain and behavior in patients. It is not known whether receiving interfascial injection while patients view their ultrasound image with doctors (visual feedback) is associated with positive treatment expectations. Methods: This was a prospective, multicenter, observational clinical trial. We evaluated whether visual feedback during ultrasound-guided interfascial injection affects treatment expectations and the subsequent course of pain in patients with myofascial pain syndrome. Treatment expectations were set as mediators of pain using path analysis. The primary endpoint was the proportion of patients who showed improvement in pain numerical rating scale score by 50% or more 14 days after initiation of treatment. Results: During 2019 and 2020, 136 outpatients received ultrasound-guided interfascial injection for myofascial pain syndrome. Of these, 65 (47.8%) patients received visual feedback during ultrasound-guided interfascial injection. Compared with the non-visual feedback group, the visual feedback group had higher expectations for treatment, immediately after interfascial injection, and their expectations were maintained at day 14 of treatment (p < .001). In the visual feedback group, 67.7% of patients showed improvement in pain numerical rating scale score by 50% or more at day 14 (95% confidence interval: 56.5–78.9), whereas such improvement was observed in only 36.6% of the non-visual feedback group (95% confidence interval: 25.3–47.9; p < .001). Path analysis revealed that visual feedback had the largest influence on pain numerical rating scale reduction at 14 days, which was indirectly via higher expectations for treatment (β = 0.434).Conclusions: Visual feedback during ultrasound-guided interfascial injection had a positive effect on the subsequent course of pain in patients with myofascial pain syndrome by increasing patients’ treatment expectations.Trial registration: UMIN000043160. Registered 28 January 2021 (registered retrospectively).

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Fascia iliaca block for pain control in hip fracture patients

Cited by 10 publications

References 31 publications

The effect of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: a randomized controlled trial

The effect of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: a randomized controlled trial

A Comparative Study on the Effects of Pre-Operative Fascia Iliaca Plane Block on Hip Surgeries Done Under Spinal Anaesthesia in Elderly Patients, vs. No Block on Post Operative Pain Scores

Effect of Visual Feedback During Ultrasound-Guided Interfascial Injection for Myofascial Pain Syndrome: A Prospective, Multicenter, Observational Clinical Trial

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