Preoperative Fascia Iliaca Compartment Block for Positioning Patients With Hip Fractures for Central Nervous Blockade

Diakomi, Maria; Papaioannou, Marianna; Μελά, Α.; Kouskouni, Evangelia; Μakris, Alexandros

doi:10.1097/aap.0000000000000133

Cited by 68 publications

(65 citation statements)

References 27 publications

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“…Guay et al [9] included seven studies and 285 participants and reported that peripheral nerve block, administered as a single shot or continuous block, resulted in less postoperative opioid requirements compared to no nerve block. Diakomi et al [37] compared FINB to IVA to facilitate positioning for femur fracture patients under spinal block. Their study results also showed that FINB had lower opioid requirements than IVA.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

Hsu

Chu

et al. 2019

PLoS ONE

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Background The evidence supporting the benefit of femoral nerve block (FNB) for positioning before spinal anesthesia (SA) in patients suffering from a femur fracture remains inconclusive. In the present study, the authors intended to determine the efficacy and safety of FNB versus an intravenous analgesic (IVA) for positioning before SA in patients with a femur fracture. Method PubMed, EMBASE, Cochrane, and Scopus databases were searched up to January 2018. We included randomized controlled studies (RCTs) and observational studies that compared FNB versus IVA for the positioning of patients with femur fracture receiving SA. The primary outcome was pain scores during positioning within 30 min before SA. Secondary outcomes were the time for SA, additional analgesic requirements, anesthesiologist’s satisfaction with the quality of positioning for SA, participant acceptance, and hemodynamic changes. A random-effects model was used to synthesize the data. We registered the study at PROSPERO with an ID of CRD42018091450. Results Ten studies with 584 patients were eligible for inclusion. FNB achieved significantly lower pain scores than IVA during positioning within 30 min before SA (pooled standardized mean deviation (SMD): -1.27, 95% confidence interval (CI): -1.84 to -0.70, p < 0.05). A subgroup analysis showed that the analgesic effect was larger in patients in the sitting position for SA than a non-sitting position (sitting position vs non-sitting: pooled SMD: -1.75 ( p < 0.05) vs -0.61 (not significant). A multivariate regression showed that the analgesic effect was also associated with age and the total equivalent amount as lidocaine after adjusting for gender (age: coefficient 0.048, p < 0.05; total equivalent amount as lidocaine: coefficient 0.005, p < 0.05). Patients receiving FNB also had a significantly shorter time for SA, greater anesthesiologist satisfaction, and higher patient acceptance than patients receiving IVA. The use of local anesthetics did not produce significant clinical hemodynamic change. Conclusion Compared to IVA, FNB was an effective and safe strategy for the positioning of femur fracture patients for a spinal block, particularly patients who received SA in the sitting position.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

Hsu

Chu

et al. 2019

PLoS ONE

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“…The use of nerve blocks has been shown to increase hip flexion following hip fracture, and enable patients to sit more comfortably . Blocks have also been shown to reduce pain during positioning for spinal anaesthesia .…”

Section: Methodsmentioning

confidence: 99%

“…All patients who received a nerve block indicated that they would prefer to receive the same management in the event of a future operation, compared with only 25% of those who received i.v. fentanyl . Table provides an itemised summary of the prospective, randomised controlled studies published to date.…”

Section: Methodsmentioning

confidence: 99%

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

et al. 2017

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Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly. There is consistent evidence that regional nerve blocks can effectively reduce pain associated with hip fracture, providing rapid-onset, site-specific analgesia that is more effective than standard systemic analgesia alone. There is also moderate evidence that nerve blocks may contribute to reduced rates of delirium, and some suggestion of reduced length of inpatient stay, morbidity and mortality, although limited evidence is available. Fascia iliaca blocks are emerging as a block of choice, with evidence they can be safely and rapidly administered under ultrasound guidance in the acute setting, by both trained medical and nursing staff, with good effect. Ideally, comprehensive pain protocols for elderly hip fracture patients are required, that integrate evidence-based fascia iliaca block use, timely and repeated pain assessment, and multidisciplinary orthogeriatric patient care.

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“…In addition, CFICB was associated with greater patient satisfaction, which was consistent with the results of Candal-Couto et al (23) and Dulaney-Cripe et al (24). Diakomi et al (31) concluded that performing an FICB prior to positioning for spinal anesthesia provided superior pain management compared with intravenous fentanyl administration facilitated spinal performance. According to Diakomi et al (31) and the present study, FICB provided superior analgesia not only prior to positioning for spinal anesthesia but also during the preoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…Diakomi et al (31) concluded that performing an FICB prior to positioning for spinal anesthesia provided superior pain management compared with intravenous fentanyl administration facilitated spinal performance. According to Diakomi et al (31) and the present study, FICB provided superior analgesia not only prior to positioning for spinal anesthesia but also during the preoperative period. The study group in the present study did not develop CFICB-associated complications.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‑guided continuous fascia iliaca compartment block for pre‑operative pain control in very elderly patients with hip fracture: A randomized controlled trial

Xue

et al. 2018

Exp Ther Med

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The present study presented the results of a prospective, randomized controlled trial. The present study enrolled 98 very elderly patients with hip fractures, complicated with at least one cardiovascular, neurological or pulmonary disease, of whom 10 patients were excluded. A total of 88 patients were randomly assigned into 2 groups: i) The control group, receiving traditional analgesia including 50 mg Tramadol and 500 mg paracetamol orally three times a day from admission to surgery; and ii) the study group, receiving ultrasound-guided continuous fascia iliaca compartment block (CFICB), a single 50 ml 0.4% ropivacaine injection with continuous infusion of 0.2% ropivacaine at a dose of 5 ml/h from admission to surgery. The primary outcome measure of pain relief or pain intensity was assessed preoperatively and up to 48 h postoperatively using a visual analog scale (VAS). The results of the present study indicated that in the preoperative period, in the morning of the day of surgery, the VAS pain at rest scores were lower in the study group compared with the control group (P=0.023). The VAS passive movement scores of the study group were also significantly lower compared with the control group 1 h following analgesia at the time of admission (P<0.05) and in the morning of the day of surgery (P<0.05). Scores for patients' satisfaction with the analgesic regimen in the preoperative period were greater in the study group compared with the control group (P<0.001). There was no difference in analgesia-associated side effects between groups. Duration of hospital stay of patients in the control group was significantly longer compared with the study group (P=0.001). Patients in the study group were less likely to have increased complications compared with patients in the control group over the N2-N4 period (from preoperative period to after surgery; P=0.016). The present study concluded that ultrasound guided CFICB was an effective method of providing analgesia for very elderly (≥80 years old) with hip fracture.

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Preoperative Fascia Iliaca Compartment Block for Positioning Patients With Hip Fractures for Central Nervous Blockade

Abstract: Performing an FICB before positioning for SA provides superior pain management compared with IVFE administration, facilitates spinal performance, and yields satisfactory postoperative analgesia and wide patient acceptance, hence improving overall quality and efficiency of care.

Cited by 68 publications

References 27 publications

Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

Efficacy and safety of femoral nerve block for the positioning of femur fracture patients before a spinal block – A systematic review and meta-analysis

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

Ultrasound‑guided continuous fascia iliaca compartment block for pre‑operative pain control in very elderly patients with hip fracture: A randomized controlled trial

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