Comparing the effectiveness of fascia iliaca block with standard analgesia in neck of femur fractures in a district general hospital emergency department—a prospective study with review of literature

Debkumar Chowdhury


Background: The incidence of hip fractures is increasing as the population ages with current estimates of 101,000 per year by the year 2020 in the United Kingdom. Pain has both a physiological and a psychological component to it. Early and effective analgesia has been proven to benefit patients and possibly lead to earlier return to baseline function. Through the years fascia iliaca blocks (FIBs) have been used as an adjunct management for analgesic relief in neck of femur fractures
Methods: We carried out a preliminary study to assess the use of stickers to document various measures of pain management. There was patchy uptake of the aforementioned stickers, we subsequently reverted back to the use of our pre-existing hip fracture proforma for documentation of pain scores. There were two main parameters measured in our study in our Emergency Department in our District General Hospital. The first parameter was the time to reassessment from initial assessment. The second parameter was assessing the effectiveness of FIBs and the associated pain scores. In total we had 42 patients included in our study over a 6-month period with 25 patients undergoing FIBs.
Results: The average time to reassessment was noted to be 72 min. In patients that underwent FIBs there was a 41.8% improvement in pain scores. From the study we noted that 9 patients refused to have the FIB (21.4%). From the 25 patients that underwent FIB, it was noted that 11 patients had no improvement of their pain scores from the pain score at reassessment (44%). However, it is worth noting the longer acting nature of the FIB provides patients with pain relief for longer periods especially if there is a delay to theatre.
Conclusions: FIBs provide an effective adjunct to analgesia. We identified various measures that could be implemented for better analgesic control in patients with neck of femur fractures. We hope to undertake studies with larger number of patients to better assess the effectiveness of FIBs.