Elsevier

Acute Pain

Volume 10, Issues 3–4, December 2008, Pages 145-149
Acute Pain

Nurse administered fascia iliaca compartment block for pre-operative pain relief in adult fractured neck of femur

https://doi.org/10.1016/j.acpain.2008.05.014Get rights and content

Summary

Aim

To assess the efficacy of fascia iliaca compartment block (FICB) administered by pain specialist nurses to relieve pain after fractured neck of femur in adults.

Method

Approval was obtained to train two pain nurses on how to perform FICB. Exclusion criteria were set out and adhered to. 30 ml of 0.25% plain bupivacaine was given to establish the block. Pain score using the visual analogue scales was documented pre-block and then at 15 min, 2 h, 8 h and 24 h after the block.

Results

Eleven male and 24 female patients aged 62–102 years had the block. The pain score at presentation for all the patients was 8–10. Fifty-four, 72.7, 77.4 and 80% of the patients had a pain score of 4 or less at 15 min, 2 h, 8 h and 24 h, respectively, after the block. The frequency for the additional analgesics varied between 0 and 2 times in 24 h post-block. There were no reported complications as a result of the procedure.

Conclusion

FICB provided pain relief after fractured neck of femur in more than 70% of patients and can be successfully performed by other trained health care providers without anaesthetic background.

Section snippets

Background

Fractured neck of femur is a common, serious and costly injury. Classically, it is a fracture of old age affecting more women than men in their 8th or 9th decade of life [1]. Approximately 70,000 patients suffer from a fractured neck of femur each year in the UK. There is a prediction that these will double as life expectancy increases and with the rising incidence of osteoporosis. The cost to the UK National Health Service is approximately one billion pound sterling per year [2]. There is

Aim of audit

This was to assess the efficacy of the fascia iliaca compartment block in the pre-operative relief of fractured neck of femur pain in adults, administered by pain specialist nurses.

Methodology

Patients in the audit were referred by Accident & Emergency doctors, the Trauma Sister or the Orthopaedic ward staff. All had radiologically confirmed hip fractures. Exclusion criteria were patient refusal, unconsciousness, dementia, anticoagulation, peripheral neuropathy, known sensitivity to local anaesthetics and body mass index greater than 40. Verbal consent was obtained from the patient preceded by an explanation of the procedure. The pain score was assessed and recorded using a visual

Results

Thirty-five blocks were administered in 24 female and 11 male patients aged between 62 and 103 years; the mean age was 82.5 years. Pain score at presentation for all the patients was 8–10. Analgesic requirement for all the patients before and after fascia iliaca compartment block was as in Table 1. Fifteen out of the 35 patients or 42.8% had surgery within 24 h of admission. Following the block, 54% of the patients had a pain score of 4 or less at 15 min. At 2 and 8 h after the block, 72.7 and

Discussion

The nerves targeted in the fascia iliaca compartment block are the lateral cutaneous, femoral and obturator nerves. The lateral cutaneous nerve of the thigh arises from the dorsal branches of the second and third lumbar rami. It passes under the inguinal ligament to supply the skin on the lateral side of the thigh. The femoral nerve is derived from the dorsal branches of the second, third, and fourth lumbar rami. It descends initially within the substance of the psoas muscle, emerges from its

Conclusion

This audit demonstrates that fascia iliaca compartment block can provide pain relief after fractured neck of femur in more than 70% of patients before surgery. It also shows that non-anaesthetic personnel can be trained to do the block successfully. Although no complications were recorded in the series, it must be emphasized that the number of patients in the audit was small.

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