Abstract
BackgroundHip fracture is common in older adults, and can cause severe post-fracture pain. Fascia iliaca nerve block has consequently been used for preoperative analgesia.MethodsWe performed a randomized, controlled, double-blind clinical trial and recruited older patients with hip fractures. These patients were randomized into two groups and received ultrasound-guided fascia iliaca compartment block using either the supra-inguinal approach (group F) or the classical approach (group C). Heart rate, blood pressure, and resting and exercising visual analog scales were recorded before the procedure and at 30 min, and 6, 12, and 24 h after completion of the procedure. We recorded the duration of the procedure—as well as complications such as bleeding, hypotension, and intractable vomiting; the sleep duration in a 24 h period was also documented.ResultsA total of 38 patients completed the trial, and we observed no differences in the baseline characteristics or pre-procedural measurements between the two groups. Compared with the patients in group C, patients in group F exhibited significantly lower exercising VAS scores at 6 and 12 h after the procedure, faster heart rates at 6 and 24 h after the procedure, a longer procedural duration, and a longer sleep duration. There were no differences in the frequencies of complications between the two groups. The percentages of patients who took oral analgesics and the numbers of medications consumed were also not different between the two groups.ConclusionsThe supra-inguinal FICB provided effective analgesia and improved exercise tolerance compared with the classical approach.Trial registrationThe trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100045644, registration date: 2021 April 20).
Highlights
Hip fracture is a common fracture, accounting for more than 20% of all fractures in older patients; and with the accelerated aging of the general population, the yearly incidence of hip fractures continues to increase [1, 2]
Previous studies have shown that nerve block effectively reduces the pain from hip fractures, and provides rapid-onset local analgesia that is more effective than conventional analgesia [1]
We interviewed 51 patients, and seven patients were excluded from the study—two with severe trauma, three on anticoagulants, and two with coagulopathy
Summary
Hip fracture is a common fracture, accounting for more than 20% of all fractures in older patients; and with the accelerated aging of the general population, the yearly incidence of hip fractures continues to increase [1, 2]. Severe pain may lead to an increased stress response and dramatic hemodynamic changes, which can trigger serious cardiovascular and cerebrovascular complications such as cerebral hemorrhage and myocardial infarction. Fascia iliaca compartment block (FICB) is being used more often for analgesia in patients with hip fractures [3, 4]. The fascia iliaca compartment is a potential cavity surrounded anteriorly by the fascia iliaca and posteriorly by the iliopsoas; and contains the femoral nerve, the obturator nerve, and the lateral femoral cutaneous nerve. FICB can block the femoral nerve, the obturator nerve, and the lateral femoral cutaneous nerve simultaneously so as to achieve satisfactory analgesia in patients with hip fractures [5]. Hip fracture is common in older adults, and can cause severe post-fracture pain. Fascia iliaca nerve block has been used for preoperative analgesia
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