Provision of fascia iliaca compartment block in the acute management of proximal femoral fractures: A national observational study of UK hospitals.
OBJECTIVE
Fascia iliaca compartment block (FICB) is a simple regional anaesthetic block that has been shown to be superior to other regional anaesthetic blocks with regards to success rate and analgesic efficacy in the acute management of proximal femoral fractures. The objective was to quantitatively assess the provision of FICB for patients with proximal femoral fractures in the UK.


METHODS
A national observational study of all acute medical trusts in the UK (n=187) was conducted. Each trust was contacted and asked to complete a freedom of information request relating to the use of regional nerve blocks in patients with a proximal femoral fracture between 2/11/2014 and 2/11/2015. The STROBE checklist was used to help design and conduct the study.


RESULTS
144/187(77.0%) of medical trusts across the UK responded. Overall, 61.8% of trusts routinely performed FICB for patients with a neck of femur (NOF) fracture. The number of trusts with a specific standardised proforma for NOF fracture patients was 127/144 (88.2%), while 83/144 (57.6%) included a section relating to FICB. 50/144 (34.7%) of trusts had no hospital related guideline for FICBs in NOF fracture patients. The use of analgesia in NOF fracture patients was audited in 95/144 (66.0%) of trusts. Where FICB was administered, the procedure was typically conducted by specialists in emergency medicine (50.6%), anaesthetics (34.6%) and orthopaedics (14.8%). Common reasons for lack of FICB provision include: lack of trained staff, resumption of adequate analgesia via other methods and a perception that there is insufficient evidence for routine use of peripheral nerve blocks improving survival and outcomes.


CONCLUSIONS
Administration of regional nerve blocks for patients with proximal femoral fractures is increasing but variable between trusts. Further work should examine how barriers to the delivery of FICBs might be addressed.
Kings College London School of Medicine, Great Maze Pond, London SE1 9RT, United Kingdom. Electronic address: George.Miller@kcl.ac.uk.
George W
GW
Miller
County Durham and Darlington NHS Foundation Trust, North Rd, Durham DH1 5TW, United Kingdom.
Jenna J
JJ
Godrey
St George's Hospital, Blackshaw Road, London, SW17 0QT United Kingdom.
Markus L
ML
Sagmeister
St George's Hospital, Blackshaw Road, London, SW17 0QT United Kingdom.
Thomas L
TL
Lewis
D000698:Analgesia / Q000379:methods*; D004636:Emergency Service, Hospital; D005205:Fascia; D005264:Femoral Fractures / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D017408:Guidelines as Topic; D006761:Hospitals; D006801:Humans; D009407:Nerve Block / Q000379:methods* / Q000706:statistics & numerical data; D059408:Pain Management / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
Anaesthetics; Clinical procedure; Emergency department; Fascia iliaca compartment block; Observational study; Orthopaedics; Proximal femoral fracture; Regional nerve block