Fascia Iliaca Compartment Block for Acute Pain Management for Hip Fracture Patient in the Emergency Department

Abstract

Introduction: Pain is a common presentation to the emergency department (ED) representing 80% of cases. Hip fracture patients are in severe pain on arrival at ED and the provision of appropriate pain relief should be a priority, but proper pain management is still not being conducted in the busy ED. Although fascia iliaca compartment block (FICB) seems to be an ideal technique as it does not require expensive equipment and easy to perform in a patient with hip fracture, it is not being used in ED in our setting. This study is designed to assess the effect of anatomic landmark-guided FICB and compare pain score using a numeric rating scale (NRS) in patients with suspected hip fracture pre- and post-block periodically at the different time frames in a resource-poor setting. Methodology: Pain assessment was administered initially with a 10-point NRS that ranged from 0 (“no pain”) to 10 (the worst pain imaginable). Patients having a pain score of more than 6 were given FICB. NRS was evaluated at presentation (−1), pre-block (0 min), and post-block at different time frames up to 6 h. Vital signs (blood pressure, respiratory rate, heart rate, pulse, and SpO2) were recorded at a predetermined time. Thirty minutes after the block, patients were transferred to X-ray where NRS was assessed while positioning for an X-ray. Results: Out of 18 patients, eight were men and the remaining 10 were female, with a mean age of 69 (SD ± 6.9) years. The mean pain score at the triage (−1 min) was 8.1 (SD ± 0.7) and before the block was 7.6 (SD ± 0.7). Over the next 6 h, the patients reported a significantly lower mean pain score with the lowest score of 2.3 (SD ± 0.4) at 180 min. Conclusion: The FICB is effective, safe and can be easily performed by emergency doctors, especially in a resource-limited setting.