Background: To determine the effectiveness of an ultrasound-guided fascia iliaca compartment block (USG FICB) as a pain control intervention for elderly hip fracture patients patients presenting to the emergency department (ED).
Methods: We conducted a prospective case-control study of 58 elderly (> 65 years of age) hip fracture patients presenting to the ED at two academic hospitals. Patients with a history of chronic pain or dementia, were excluded due to their altered acute pain perception or ability to report pain accurately. There were twenty-nine elderly hip fracture patients who received an USG FICB using 0.5% Ropivacaine (3mg/kg, max 150mg) with 1% lidocaine (10mL) preoperatively. Each case was matched by fracture location, age, and gender to a control patient who was not blocked. The primary outcome measure was pain intensity which was assessed preoperatively and up to 48 h postoperatively using a visual analog scale (VAS). Secondary outcomes included perioperative total oral morphine equivalents and hospital length of stay (LOS). Paired t-tests and ANOVA were used to detect statistically significant group differences
Results: Overall, 41% of the blocks (12/29) were performed within 180 minutes of arrival. Block cases reported an average baseline pain score of 6.4+3.0 with a pain score of 3.5+3.2 (p=0.0002) after receiving an USG FICB. Patients who received an USG FICB used an average of 25 total morphine equivalents, while control patients who did not receive a block used an average of 34 total morphine equivalents during their hospital stay (p=0.035). There was no statistically significant difference in the mean hospital length of stay between the two groups (4.2 vs. 4.5, p=0.50).
Conclusions: This multi-specialty collaborative initiative has achieved a modest reduction in pain scores and total oral morphine equivalents required for the management of elderly patients with hip fractures.