Regional analgesia in the emergency department for hip fractures: survey of current UK practice and its impact on services in a teaching hospital

Abstract

RA for HFs is not widely used in UK EDs, proving that there is room for improvement .The finding that RA blocks are performed by the ED medical staff in 84% of the responding EDs practising RA was reassuring for developing the service in our hospital. FICB should be considered as an alternative to parenteral analgesia in adult patients with HF.

Standard Preoperative Analgesia with or without Fascia Iliaca Compartment Block for Femoral Neck Fractures

“…10,11 Up to 84% of emergency departments in the UK use regional anaesthesia for hip fracture patients; FICB is the first-line regional anaesthesia. 5 This has led to the introduction of a nurse-led FICB service for patients with femoral neck fracture. [12][13][14] The analgesic reliability of FICB has led to its introduction in the pre-hospital setting in some countries.…”

“…15 Bupivacaine has been used to investigate the analgesic effect of FICB. [3][4][5][7][8][9][10][11][12][13] It has a rapid onset (2-5 minutes), 16,17 with the maximum plasma level occurs after 15 to 30 minutes. 18 It has fewer toxic reactions relative to lidocaine, 19 with a half-life of 157 minutes, 20 and its local anaesthetic effect lasts for up to 8 hours.…”

“…5,11,14,15 Limitations of this study included the small sample size, and selection and operator bias that may have occurred when assessing VAS for pain. Patients and staff expectations of FICB may have influenced the subjective VAS for pain.…”

“…3 Nonetheless, its use has been limited due to a lack of trained staff or appropriate equipment in direct care personnel. 5 The National Institute for Health and Care Excellence guidelines recommend the use of nerve blocks in selected patients to provide additional analgesia and/or limit opioid dosage. 2,6 This study compared the visual analogue score (VAS) for pain in patients with femoral neck fracture who received the standard preoperative analgesia with or without FICB.…”

SGEM Hot Off the Press: Regional Nerve Blocks for Hip and Femoral Neck Fractures: A Systematic Review

“…One small study actually demonstrated feasibility in pre-hospital settings, 13 but regional anaesthesia is not commonly used in the contemporary ED. 14,15 Dr. Chris Carpenter posed the question of how to learn to perform ultrasound-guided nerve blocks and asked about the learning curve for the procedure. Drs.…”