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

Williams, Huw L M; Paringe, V.; Shenoy, Shrisha; Michaels, Phil; Ramesh, B.

doi:10.1177/230949901602400109

Cited by 39 publications

(28 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among those studies reviewed, those that utilised ultrasound guidance and sampled a large patient population demonstrated the most significant positive effects of regional blockade. There is also consistent evidence that the use of regional nerve blocks can reduce the consumption of opiates following hip fracture , and reduce the incidence of opiate side‐effects and overdose .…”

Section: Methodsmentioning

confidence: 89%

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 89%

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

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Williams et al [14] and Groot et al [15], in their respective studies, showed that FIB was better as compared to intravenous analgesics. Williams et al [14] used 30 mL of 0.25% levobupivacaine, resulting in a reduction of VAS score to less than 3 in 15 minutes, and analgesia lasted up to 8 hours as compared to intravenous opioids, with a P < 0.001 which was highly significant. This can be due to a slower onset but prolonged duration of action for levobupivacaine.…”

Section: Discussionmentioning

confidence: 98%

“…Bupivacaine has been used previously for analgesia in both the FNB and FIB [4,9,14,17,21]. With an onset of action between 2 and 5 minutes, the maximum plasma levels are reached in 15-30 minutes [22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: an observational study

Gupta

Kamath

2020

Korean J Pain

View full text Add to dashboard Cite

Background: Severe pain associated with proximal femur fractures makes the positioning for regional anesthesia a challenge. Systemic administration of analgesics can have adverse effects. Individually, both the fascia iliaca block (FIB) and femoral nerve blocks (FNB) have been studied. However, there is little evidence comparing the two. The aim of this study was to compare the overall efficacy of the two blocks in patients with proximal femur fracture before positioning for spinal anesthesia. Methods: ASA (American Society of Anesthesiologists) class I, II, and III patients scheduled for elective and emergency surgery with the diagnosis of proximal femur fracture between October 2018 and June 2019 were included in the study. The patients were assigned to two groups by convenience nonprobability sampling of 35 each. Results: Our study showed a reduction in visual analogue scale scores at 3, 4, and 5 minutes after administration of the FIB being 5.1 ± 1.1, 4.1 ± 1.3, and 2.8 ± 0.8, and those after the FNB as 4.4 ± 1.1, 3.3 ± 1.1, and 2.1 ± 1.4 with P < 0.05, which was statistically significant. The mean first rescue analgesia time for the FIB was 7.1 ± 2.1 hours, while for the FNB it was 5.2 ± 0.7 hours. The P value was less than 0.001, which was significant. Conclusions: Both ultrasound guided FNB and FIB techniques provide sufficient analgesia for patient's positioning before spinal anesthesia. However, the duration of postoperative analgesia provided by FIB was greater than that of the FNB.

show abstract

“…Other methods of analgesia, which have shown benefit in femoral neck fractures, include fascia iliaca blocks by reducing the need for additional opioid analgesia. 12 …”

Section: Introductionmentioning

confidence: 99%

Using Care Bundles to Improve Surgical Outcomes and Reduce Variation in Care for Fragility Hip Fracture Patients

Bandara

Lynch

Cooke

et al. 2017

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction:Fragility hip fractures constitute a large proportion of orthogeriatric admissions to orthopedic wards. This study looked at reducing variation in care in fragility hip fracture patients using a novel approach with care bundles. The care bundle comprises 5 elements targeted at providing adequate analgesia, early mobilization, improving recognition of delirium, and decreasing rates of urinary infections.Methods:A total of 198 patients who sustained a fragility hip fracture during the intervention period were included in the study. The primary outcome measure was compliance in applying the bundle to the study population, and secondary outcome measures were in-hospital mortality, acute length of stay, delirium and duration of delirium, and urinary tract infections.Results:During the 12-month intervention period, compliance to the bundle of care was 47% (n = 92) based on the “all-or-none” approach. This was 28% higher than the preintervention rate. Overall, there was an increased rate of compliance across all individual elements of the bundle in the intervention group when compared to the preintervention group (P = .01). The most significant clinical result was a 10.5% reduction in “in-hospital mortality” in the intervention group (P < .001).Conclusion:This study demonstrated that the implementation of specific care bundle in patients with fragility hip fracture significantly reduces variation in care.

show abstract

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

Cited by 39 publications

References 19 publications

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

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

Comparison of preoperative ultrasound guided fascia iliaca block versus femoral nerve block for proximal femur fractures before positioning for spinal anesthesia: an observational study

Using Care Bundles to Improve Surgical Outcomes and Reduce Variation in Care for Fragility Hip Fracture Patients

Contact Info

Product

Resources

About