Regional analgesia in the emergency department for hip fractures: survey of current UK practice and its impact on services in a teaching hospital.

INTRODUCTION

While the benefits of regional analgesia (RA) for preoperative pain relief in hip fracture (HF) in elderly patients are well recognised, this service is yet to be established in many UK emergency departments (EDs). We set out to discover how widely RA is adopted in the UK EDs.

METHODS

In April-July 2010, we conducted a postal survey of 218 UK EDs, followed up with fax reminders for non-respondents.

RESULTS

A total of 147/218 (67%) EDs completed the survey. Sixty five (44%) respondents reported use of RA blocks for HF. The commonest stated reasons for not using RA were lack of trained staff (36%) or appropriate equipment (22%). RA users practiced femoral nerve block most widely (60% of EDs) followed by fascia iliaca compartment block (FICB) (22%).

DISCUSSION

It is more a lack of trained staff and suitable equipment that prevents RA blocks being widely adopted in the UK. We advocate FICB in HF patients, which is an easy landmark-based block that can be safely performed by ED doctors. Our survey initiated multidisciplinary consultation and development of a protocol for preoperative FICB in HFs in our teaching hospital ED.

CONCLUSIONS

RA for HFs is not widely used in UK EDs, proving that there is room for improvement .The finding that RA blocks are performed by the ED medical staff in 84% of the responding EDs practising RA was reassuring for developing the service in our hospital. FICB should be considered as an alternative to parenteral analgesia in adult patients with HF.