Fascia iliaca blocks linked with decreased opioid use after hip fracture surgery
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Preoperative fascia iliaca compartment blocks were associated with decreased postoperative pain and opioid consumption while improving functional recovery in older patients with proximal femur fractures, according to presented results.
“Appropriate postoperative pain control in the geriatric population is important, yet can be difficult to balance,” Jeffrey Thompson, DO, a resident physician from the department of orthopedics at Nassau University Medical Center, said in his presentation at the Orthopaedic Trauma Association Annual Meeting, which was held as a virtual event.
“We know that the over-administration of systemic pain control modalities, such as opioids, has been associated with somnolence and delirium which, in turn, limits functional recovery and increases complications,” Thompson said. “However, inadequate postoperative pain control has also been shown to lead to delirium, decreased mobility and limited functional recovery, which extends hospital stays and also increases postoperative complications.”
Thompson and colleagues examined the safety and efficacy of a fascia iliaca compartment block (FICB) as a regional pain control modality for 47 patients aged 60 years or older who were diagnosed with acute femoral neck fractures, intertrochanteric femur fractures or subtrochanteric femur fractures.
Researchers allocated 23 patients to the experimental group and 24 patients to the control group. Prior to anesthesia, the experimental group received an ultrasound-guided FICB, a 30 cc 0.25% ropivacaine injection that desensitized the obturator, femoral and lateral femoral cutaneous nerves for 48 hours, Thompson said.
Thompson and colleagues used an institutional geriatric hip fracture protocol for pain control, which is based on VAS pain scores, he said. Patients who reported mild pain (1 to 3) received either oral or IV acetaminophen. Patients who reported moderate pain (4 to 9) received tramadol. Patients who reported breakthrough pain (7 to 10) received an opioid.
According to the study, outcome measures included consumption of opioids from postoperative day 0 to postoperative day 3, functional recovery, which was measured in the number of steps taken on postoperative day 3, and a subjective patient-satisfaction questionnaire.
Thompson and colleagues found patients who received the FICB had a significant decrease in tramadol and opioid consumption, a significant increase in patient satisfaction and a “trend toward significant” improvement in ambulation at postoperative day 3.
Patients in the experimental group received 97.8 mg of tramadol and 0.4 mg of opioids, while patients in the control group received 170.4 mg and 19.4 mg, respectively.
“The FICB is a safe and effective modality to help control postoperative pain following surgical fixation of proximal femur fractures,” Thompson concluded. “The block was able to significant decrease postoperative opioid consumption, as well as increase functional recovery and patient satisfaction. We recommend the integration of this block into institutional geriatric hip fractures protocols as an adjunctive pain control strategy.”
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Thompson J, et al. Fascia iliaca block decreases hip fracture postoperative opioid consumption: A prospective randomized controlled trial. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20-24, 2020 (virtual meeting).
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