Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

doi:10.5847/wjem.j.1920-8642.2015.02.010

Abstract

Abstract:

BACKGROUND: Fascia iliaca compartment nerve block (FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.
METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group (n=20) and a control group (n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the first 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale (VAS), total analgesic consumption, and the time for the first analgesic request.
RESULTS: VAS pain scores were reduced within the first 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values (IQR) 0.00 (0.00) vs.18.00 (30.00), P=0.001; at 6 hours 0.00 (0.00) vs. 34.00 (20.75), P=0.000; at 24 hours 12.50 (10.00) vs. 31.50 (20.75), P=0.004; and at 12 hours (17.80±12.45) vs. (29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the first analgesic request was significantly prolonged (417.50 vs. 139.25 minutes, P=0.000).
CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the first analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.

Key words: Surgery, Femoral bone fracture, Fascia iliaca compartment nerve block, Postoperative pain

Fentahun Tarekegn Kumie, Endale Gebreegziabher Gebremedhn, Hailu Yimer Tawuye. Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture[J]. World Journal of Emergency Medicine, 2015, 6(2): 142-146.

Figures/Tables 3

Table 1

Table 2

Figure 1.

References 20

1	Admassie D, Yirga T, Wamisho LB. Adult limb fractures in Tikur Anbessa Hospital caused by road traffic injuries: Half year plain radiographic pattern. Ethiop J Health Dev 2010; 24:61-63.
2	Newman B, McCarthy L, Thomas PW, May P, Layzell M, Horn K. A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. Anaesthesia 2013; 68:899-903.
3	Hanna L, Gulati L, Graham A. The role of fascia iliaca blocks in hip fractures: A prospective case-control study and feasibility assessment of a junior-doctor-delivered service. Hindawi Publishing Corporation 2014.
4	Dalens B, Vanneuville G, Alain Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg 1989; 69:705-713. pmid: 2589650
5	Lopez S, Gros T, Bernard N, Plasse C, Capdevila X. Fascia iliaca compartment block for femoral bone fractures in prehospital care. Reg Anesth Pain Med 2003; 28:203-207. pmid: 12772137
6	Høgh A, Dremstrup L, Jense SS, Lindholt J. Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture. Strat Traum Limb Recon 2008; 3:65-70.
7	Dolan J, Williams A, Murney E, Kenny NCG. Ultrasound guided fascia iliaca block: A comparison with the loss of resistance technique. Reg Anesth Pain Med 2008; 33:526-531.
8	Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubenovitch J, d'Athis F. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg 1998; 86:1039-1044. pmid: 9585293
9	Leeper DA, Brandon PT, Morgan AVM, Cutts S, Cohen AMM. Fascia iliaca compartment block reduces morphine requirement pre-operatively for patients with fractured neck of femur. Eur J Trauma Emerg Surg 2012; 38:673-677.
10	Kaldirim U, Yolcu U. Fascia iliaca compartment block for hip dislocation. Eur J Emerg Med 2015; 22:145-146.
11	Chu RS, Browne GJ, Cheng NG, Lam LT. Femoral nerve block for femoral shaft fractures in a paediatric Emergency Department: can it be done better? Eur J Emerg Med 2003; 10:258-263. pmid: 14676500
12	Fujihara Y, Fukunishi S, Nishio S, Miura J, Koyanagi S, Yoshiya S. Fascia iliaca compartment block: its efficacy in pain control for patients with proximal femoral fracture. J Orthop Sci 2013; 18:793-797.
13	Monzón GD, Vazquez J, Jauregui RJ, Iserson VK. Pain treatment in post traumatic hip fracture in the elderly: regional block vs. systemic nonsteroidal analgesics. Int J Emerg Med 2010; 3:321-325.
14	Yun JM, Kim HY, Han KM, Kim HJ, Hwang WJ, DO HS. Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block. Acta Anaesthesiol Scand 2009; 53:1282-1287. pmid: 19650803
15	Martinez KA, Snyder CF, Malin JL, Dy SM. Is race/ethnicity related to the presence or severity of pain in colorectal and lung cancer? J Pain Symptom Manage 2014; 48:1050-1059.
16	Matutina ER, Mueller M, Kelechi JT. Racial differences in pain reports between black and white participants with chronic venous disorders treated with cryotherapy compared to usual care. Ethn Dis 2011; 21:451-457. pmid: 22428349
17	Degu G, Tessema F. Lecture notes for health science students biostatistics. University of Gondar 2005; 184.
18	Foss BN, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients. Anesthesiology 2007; 106:773-778. pmid: 17413915
19	Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthopaed Traumatol 2009; 10:127-133.
20	Wathen EJ, Gao D, Merritt G, Georgopoulos G, Battan KF. A Randomized Controlled Trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department. Ann Emerg Med 2007; 50:162-171.

Variables	Cases (n=20)	Controls (n=20)	Pvalue
Age (year)	28.22±4.52^*	29.00±9.32^*	0.708
Weight (kg)	56.25±6.19^*	54.55±5.39^*	0.361
Height (cm)	170.60±3.69^*	169.55±3.47^*	0.360
Body mass index (kg/m²)	19.62±1.73^*	18.98±1.96^*	0.281
Intraoperative anesthesia time (minute)	169.75±61.01^*	138.00±29.78^*	0.044
Total intraoperative tramadol (mg)	2.50±11.18^*	5.00±15.38^*	0.561
Sex
Male	18 (90%)	16 (80%)
Female	2 (10%)	4 (20%)	0.661
ASA physical status
I	17 (85%)	18 (90%)
II	3 (15%)	2 (10%)	0.605

Variables	Cases (n=20)	Controls (n=20)	Pvalue
VAS scores at 2 hours	0 (0)	18.00 (30.00)	0.001
VAS scores at 6hours	0 (0)	34.00 (20.75)	0.000
VAS scores at 12hours	17.00 (17.75)	26.50 (19.25)	0.006
VAS scores at 24hours	12.50 (10)	31.50 (20.75)	0.001

[1]	William Gilliam, Jackson F. Barr, Brandon Bruns, Brandon Cave, Jordan Mitchell, Tina Nguyen, Jamie Palmer, Mark Rose, Safura Tanveer, Chris Yum, Quincy K. Tran. Factors associated with refractory pain in emergency patients admitted to emergency general surgery [J]. World Journal of Emergency Medicine, 2021, 12(1): 12-17.
[2]	Xiao-ru Che, Yong-jie Wang, Hai-yan Zheng. Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery [J]. World Journal of Emergency Medicine, 2020, 11(3): 169-173.
[3]	Seong K. Lee, Eddy H. Carrillo, Andrew Rosenthal, Rafael Sanchez, Chauniqua Kiffin, Dafney L. Davare. Acute Care/Trauma Surgeon's role in obstetrical/gynecologic emergencies (The OBCAT Alert) [J]. World Journal of Emergency Medicine, 2016, 7(4): 274-277.
[4]	Hui-ming Zhu, Shao-qing Guo, Xiu-min Liao, Li Zhang, Li Cai. Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome [J]. World Journal of Emergency Medicine, 2015, 6(1): 23-28.
[5]	Quan-yue Li, Dong-hai Zhao, Hai-yan Qu, Chuan-nong Zhou. Life-threatening complications of ascariasis in trauma patients: a review of the literature [J]. World Journal of Emergency Medicine, 2014, 5(3): 165-170.
[6]	Mayank Jayant, Robin Kaushik. Abdominal cocoon in a young man [J]. World Journal of Emergency Medicine, 2014, 5(3): 234-236.
[7]	Xue-zhong Xing, Hai-jun Wang, Chu-lin Huang, Quan-hui Yang, Shi-ning Qu, Hao Zhang, Hao Wang, Yong Gao, Qing-ling Xiao, Ke-lin Sun. Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery [J]. World Journal of Emergency Medicine, 2012, 3(4): 278-281.