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

Abstract

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.

Fascia Iliaca Compartment Block for Perioperative Pain Management of Geriatric Patients with Hip Fractures: A Systematic Review of Randomized Controlled Trials

“…In addition, 9 studies [ 25 , 30 , 40 – 44 , 46 , 49 ] were not designed as blinded. Although another 5 studies [ 24 , 29 , 36 , 39 , 50 ] were designed as blinded, they did not describe the blinding method in detail.…”

“…They concluded that FICB is nearly as effective for up to about 8 h after administration and can effectively control post-hip fracture pain, with a rapid onset. Later in 2018, Ma et al [ 29 ] evaluated the use of FICB in the very older adults (over 80 years) with hip fractures, with a traditional method (50 mg tramadol plus 500 mg paracetamol, orally, three times a day) set as controls. Outcomes revealed that the VAS pain scores under different phases in patients who had received FICB were significantly lower than those of the controls, including scores at rest and in the morning of the day of surgery, as well as passive movement scores at 1 h after analgesia at the time of admission and in the morning of the day of surgery.…”

“…In addition to the above advantages, FICB technique may also bring other benefits in geriatric patients with hip fractures. Many studies reported that the use of FICB could reduce the risk of perioperative complications, such as delirium, pruritus, nausea, and vomiting [ 48 – 50 ], decrease the length of hospital stay, and accelerate functional recovery [ 29 , 57 , 58 ] ( Table 3 ).…”

“…In addition to the decreased risk of complications, FICB can also help reduce the length of hospital stay and accelerate the functional recovery. A previous RCT [ 29 ] reported that the mean length of hospital stay in patients that received FICB was significantly shorter than that of the controls. Similarly, Lees et al [ 57 ] found the acute length of hospital stays in patients managed by FICB decreased to an average of 9.9 days, compared with 15 days of the control group.…”

Comparison of the Effectiveness of Suprainguinal Fascia Iliaca Compartment Block and Patient-Controlled Analgesia for Major Hip Surgeries in Elderly Patients

“…Furthermore, recent meta-analyses have suggested that efficiency of FICB and application approaches should be studied further ( 9 ). It has been suggested that continuous FICB performed using a conventional technique provides better pain control than patient-controlled analgesia (PCA) in elderly patients ( 10 ). To the best of our knowledge, no study in the current literature has evaluated the effect of the suprainguinal technique, especially in the elderly population.…”