title: Single Fascia Iliaca Compartment Block is Safe and Effective for Emergency Pain Relief in Hip-fracture Patients.
abstract: BACKGROUND
  Currently, it is common practice in the emergency department (ED) for pain relief in hip-fracture patients to administer pain medication, commonly systemic opioids. However, with these pain medications come a high risk of side effects, especially in elderly patients. This study investigated the safety profile and success rate of fascia iliaca compartment block (FICB) in a busy ED. This ED was staffed with emergency physicians (EPs) and residents of varying levels of experience. This study followed patients' pain levels at various hourly intervals up to eight hours post procedure.
  
  
  METHODS
  Between September 2012 and July 2013, we performed a prospective pilot study on hip-fracture patients who were admitted to the ED of a teaching hospital in the Netherlands. These patients were followed and evaluated post FICB for pain relief. Secondary outcome was the use of opioids as rescue medication.
  
  
  RESULTS
  Of the 43 patients in this study, patients overall experienced less pain after the FICB (p=0.04). This reduction in pain was studied in conjunction with the use and non-use of opioids. A clinically meaningful decrease in pain was achieved after 30 minutes in 62% of patients (54% with the use of opioids, 8% without opioids); after 240 minutes in 82% of patients (18% with opioids, 64% without opioids); after 480 minutes in 88% of patients (16% with opioids, 72% without opioids). No adverse events were reported.
  
  
  CONCLUSIONS
  In a busy Dutch ED with rotating residents of varying levels of experience, FICB seems to be an efficient, safe and practical method for pain reduction in patients with a hip fracture. Even without the use of opioids, pain reduction was achieved in 64% of patients after four hours and in 72% of patients after eight hours.
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Department of Emergency Medicine, Amsterdam, Netherlands.
authors.forename: Leonieke
authors.initials: L
authors.lastname: Groot
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Department of Emergency Medicine, Amsterdam, Netherlands.
authors.forename: Lea M
authors.initials: LM
authors.lastname: Dijksman
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Department of Emergency Medicine, Amsterdam, Netherlands.
authors.forename: Maarten P
authors.initials: MP
authors.lastname: Simons
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Department of Emergency Medicine, Amsterdam, Netherlands.
authors.forename: Mariska M S
authors.initials: MM
authors.lastname: Zwartsenburg
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Department of Emergency Medicine, Amsterdam, Netherlands.
authors.forename: Jasper R
authors.initials: JR
authors.lastname: Rebel
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005205:Fascia / Q000187:drug effects*; D005260:Female; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block / Q000379:methods*; D009426:Netherlands; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine