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

Rashid, Anwar; Beswick, Eleanor; Fitton, Larry; Galitzine, Svetlana

doi:10.1097/00003643-201206001-00409

Cited by 2 publications

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“…Fascia iliaca compartment block (FICB)—a local anaesthetic injection directly into the groin region—is routinely used in the emergency department by medical and, increasingly, nurse practitioners. It has equal pain relief to opioids and fewer side effects, potentially improving patient outcomes and length of hospital stay 14 19–27. The Association of Anaesthetists of Great Britain and Ireland supports delivery of FICB by trained non-medical health professionals 28.…”

Section: Introductionmentioning

confidence: 99%

Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study

et al. 2019

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ObjectiveTo explore patients’ experience of receiving pain relief injection for suspected hip fracture from paramedics at the location of the injury.DesignQualitative interviews within a feasibility trial about an alternative to routine prehospital pain management for patients with suspected hip fracture.SettingPatients treated by paramedics in the catchment area of one emergency department in South Wales.ParticipantsSix patients and one carer of a patient who received fascia iliaca compartment block (FICB).InterventionFICB administered to patients with suspected hip fracture by trained paramedics. We randomly allocated eligible patients to FICB—a local anaesthetic injection directly into the hip region—or usual care—most commonly morphine—using audited scratch cards.OutcomesAcceptability and experience of receiving FICB, assessed through interview data. We audio-recorded, with participants’ consent, and conducted thematic analysis of interview transcripts. The analysis team comprised two researchers, one paramedic and one lay member.ResultsPatients had little or no memory of being offered, consenting to or receiving FICB. They recalled the reassuring manner and high quality of care received. They accepted FICB without question. Partial or confused memory characterised experience of subsequent hospital care until surgery. They said their priorities when calling for emergency help were to receive effective care. After hospital treatment, they wanted to regain their health and mobility and resume the quality of life they experienced before their injury.ConclusionsThis study did not raise any concerns about the acceptability of FICB administered at the scene of injury by paramedics to people with suspected hip fracture. It adds to existing evidence about patient and carer experience of on-scene care for people with suspected hip fracture. Further research is needed to assess safety, effectiveness and cost effectiveness of this health technology in a new setting.Trial registration numberNCT60065373.

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Section: Introductionmentioning

confidence: 99%

Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study

et al. 2019

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Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial

Bulger

Brown

Evans

et al. 2017

Pilot Feasibility Stud

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BackgroundAdequate pain relief at the point of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia iliaca compartment block (FICB) is a procedure routinely undertaken by doctors and nurses in the emergency department for patients with hip fracture but not yet evaluated for use by paramedics at the scene of emergency calls.In this feasibility study, we aim to test whether FICB administered by paramedics at the scene of participants’ hip fractures is feasible, safe and acceptable. This will enable us to decide whether to proceed to a fully powered, multi-centre pragmatic randomised trial to evaluate whether the procedure is effective for patients and worthwhile for the NHS.Methods/designIn this study, we propose to recruit ten paramedics in an urban area of South Wales. We will train them to carry out FICB when they attend patients with hip fracture. We will randomly allocate eligible patients to FICB or usual care using audited scratch cards. We will follow up participants to assess measurability of key outcomes including quality of life, pain scores, adverse events, length of stay in hospital, acceptability to patients and compliance of paramedics. We will assess whether the findings meet specified feasibility criteria and, if so, plan a full trial.DiscussionThis study will enable us to recommend whether to undertake a definitive trial of FICB by paramedics for hip fracture.Trial registration ISRCTN60065373

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

Cited by 2 publications

References 1 publication

Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study

Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study

Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial

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