title: Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial.
abstract: BACKGROUND
  Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. These injuries are painful, and the need for extrication and transport adds complexity to the management of this condition. Whereas traditional analgesia involves parenteral opioids, regional nerve blockade for femoral fractures have been demonstrated to be effective when performed by physicians. Regional peripheral nerve blockade performed by paramedics may be suitable in the prehospital setting.
  
  
  OBJECTIVE
  To examine the efficacy and feasibility of paramedic-performed fascia iliaca compartment block (FICB) for patients with suspected hip or femur fractures in the prehospital setting compared to intravenous morphine alone.
  
  
  METHODS
  Prior to treatment allocation, all patients received a loading dose of morphine intravenously, then received either 1) FICB using lidocaine with epinephrine; or 2) standard care (further intravenous morphine only) in this nonblinded, randomized control trial. Participants rated their pain using a standard 11-point verbal numerical rating scale prior to and 15 min after receiving the allocated treatment. Secondary outcomes included effectiveness at other time points and incidence of adverse effects.
  
  
  RESULTS
  We analyzed 11 and 13 patients in the FICB and standard care groups, respectively. Patients treated with FICB had a greater reduction in their median pain score than patients in the standard care group (50% vs. 22%, p = 0.025) after 15 min. In the FICB group, median pain scores decreased by 5 (interquartile range 4-6), compared to 2 (interquartile range 0-4) in the standard care group. The FICB procedure did not significantly impact on scene times. No immediately obvious adverse events were noted in the 11 participants who received FICB from paramedics.
  
  
  CONCLUSIONS
  The study suggests that FICB can be performed by trained paramedics for patients with suspected femoral fractures.
authors: NSW Ambulance, Rozelle, New South Wales, Australia; School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia.
authors: Paul J
authors: PJ
authors: McRae
authors: NSW Ambulance, Rozelle, New South Wales, Australia; School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia; Department of Anaesthesia, Gosford Hospital, Gosford, New South Wales, Australia.
authors: Jason C
authors: JC
authors: Bendall
authors: NSW Ambulance, Rozelle, New South Wales, Australia; School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia.
authors: Veronica
authors: V
authors: Madigan
authors: School of Biomedical Sciences, Charles Sturt University, Bathurst, New South Wales, Australia; Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors: Paul M
authors: PM
authors: Middleton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D005264:Femoral Fractures / Q000150:complications*; D006801:Humans; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: analgesia; emergency medical services; fascia iliaca compartment block; femur fracture; neck of femur fracture; nerve block; paramedic; regional anesthesia