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