What is the clinical evidence from this study?

Study design: RCT. Population: Hip fractures (n=88). Intervention: Ultrasound guided femoral nerve block (FNB) vs. Blind fascia iliaca compartment block (FICB) with 40 ml of Marcaine 0.25%. Primary outcome: Proportion of patients with an NRS pain score ≤ 3 at rest 3 hours after intervention (p=0.25).

January 1, 2020Open Access

Preoperative Pain Management of Patients with Hip Fractures: Blind Fascia Iliaca Compartment Block Compared to Ultrasound Guided Femoral Nerve Block—A Randomized Controlled Trial

Key Result

Ultrasound guided femoral nerve block and blind fascia iliaca compartment block were equally effective in providing preoperative pain management for patients with hip fractures, with no significant difference in pain scores at rest.

Study Design

Type

RCT (n=88)

Blinding

Open-label

Randomization

1:1 internet-based

Multicenter

Structured PICO

Does blind fascia iliaca compartment block provide equal pain relief compared to ultrasound guided femoral nerve block in patients with hip fractures?

Population

88 patients with hip fractures in Danish emergency departments (67 included in statistical analysis)

Intervention

Blind fascia iliaca compartment block (FICB)

Comparator

Ultrasound guided femoral nerve block (FNB)

Outcome

Proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administrationpatient reported

Blind fascia iliaca compartment block and ultrasound guided femoral nerve block are equally effective for preoperative pain management in patients with hip fractures.

Main Result

Absolute Event Rate: 76.5% vs 63.6%

p-value: p=0.25

Limitations

High proportion of missing data (only 76% of recruited patients were included for data analysis)
Patients with dementia were excluded due to ethical considerations, limiting generalizability
Lack of blinding could potentially bias the patient-reported pain scores
Blocks were performed by 19 different anesthetists with varying levels of experience, potentially contributing to a lower overall success rate

Abstract

Introduction: Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy in pain management of these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. Method: We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administration. Results: A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with an NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). Conclusion: Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally efficient in providing pain management in the preoperative period.

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