title: Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture.
abstract: This study investigate the efficacy of pre-operative pain treatment for patients with hip fractures using fascia lliaca compartment block (FIB) technique performed by junior registrars (JR) as a supplement to conventional pain treatment. The FIB technique has routinely been used pre-operatively in the emergency department since 1 January 2004 for all patients with hip fractures. Over an 8-month period, 187 patients were treated. FIB was performed with 40 ml lidocaine and bubivacaine. A simple 5-step verbal pain score and maximal passive hip flexion was used as objective and subjective pain measurements. Effect of FIB was prospectively assessed on 70 patients: 2/3 females, mean age 80.7 (SD = 7.8), 36% in ASA-group III and IV (95% CI, 0.25-0.48). The median pain-free hip flexion pre-block was 15 degrees (SD = 17) this improved to a median of 28 degrees (SD = 21) 15 min post-block (P = 0.014) and 37 degrees (SD = 26) 60 min post-block (P = 0.030). The median simple verbal pain score (0-4) pre-block was 2.2 (SD = 0.92). This decreased to a median of 1.5 (SD = 0.78) 15 min post-block (P < 0.001) and 1.3 (SD = 0.71) 60 min post-block (P = 0.021). No side-effects were observed. There was no correlation between the number of FIB previously performed by the attending registrar and the improved maximal hip flexion (rho = 0.090, P = 0.50) or reduction in subjective pain score (rho = 0.005, P = 0.971). FIB performed by JR is a feasible, efficient pre-operative supplement to conventional pain-treatment for patients with hip fractures. FIB is easy to perform, requires minimal introduction, no expensive equipment and is connected with a minimal risk approach.
authors.affiliation: Department of Orthopedic Surgery, Viborg District Hospital, Viborg, Denmark, a_l_hogh@yahoo.dk.
authors.forename: Annette
authors.initials: A
authors.lastname: Høgh
authors.forename: Lene
authors.initials: L
authors.lastname: Dremstrup
authors.forename: Steffen Skov
authors.initials: SS
authors.lastname: Jensen
authors.forename: Jes
authors.initials: J
authors.lastname: Lindholt