Department of Emergency Medicine, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
Department of Emergency Medicine, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
Am J Emerg Med. 2020 Feb;38(2):231-236. doi: 10.1016/j.ajem.2019.02.011. Epub 2019 Feb 11.
In the Emergency Department, regional anesthesia is increasingly used in elderly patients with hip fractures. An example is a Fascia Iliaca Compartment Block (FICB). Traditionally, this block is administered below the inguinal ligament. There is no Emergency Department data regarding effectivity of an alternative, more cranial approach above the inguinal ligament. The objective was to determine analgesic effects of an ultrasound-guided supra-inguinal FICB in hip fracture patients in the Emergency Department.
This case series included all Emergency Department hip fracture patients who were treated with a supra-inguinal FICB during a period of 10 months. All data were recorded prospectively. Primary study outcome was decrease in Numerical Rating Scale (NRS) pain scores 60 min after the FICB. Secondary outcomes included the proportion of patients achieving 1.5 NRS points decrease at 60 min; NRS differences at 30 and 120 min compared to baseline; need for additional analgesia and occurrence of adverse events.
A total of 22 patients were included in the study. At 60 min median NRS pain scores decreased from 6.0 to 3.0 (p < 0.001). Of all patients, a total of 59% achieved a decrease in 1.5 NRS points after 60 min. Median pain scores at 30 and 120 min were 4.0 (Interquartile Range (IQR) 2.0-5.0) and 2.5 (IQR 0.8-3.0). Seven patients (31.8%) required additional opioid analgesia after the FICB. No adverse events were recorded.
An ultrasound-guided supra-inguinal FICB decreases NRS pain scores in hip fracture patients both clinically relevant and statistically significantly after 60 min.
The study was registered in the ISRCTN database (ISRCTN74920258).
在急诊科，越来越多的老年髋部骨折患者采用区域麻醉。例如，股外侧肌间隔阻滞（FICB）。传统上，这种阻滞在腹股沟韧带下方进行。在急诊科，关于替代方法（即腹股沟韧带上方更颅侧的方法）的有效性，尚无相关数据。目的是确定超声引导下髂筋膜间隙阻滞在急诊科髋部骨折患者中的镇痛效果。
本病例系列研究纳入了在 10 个月期间接受髂筋膜间隙阻滞的所有急诊科髋部骨折患者。所有数据均前瞻性记录。主要研究结果是 FICB 后 60 分钟时数字评分量表（NRS）疼痛评分的下降程度。次要结局包括：60 分钟时 NRS 评分降低 1.5 分的患者比例；与基线相比，30 分钟和 120 分钟时 NRS 差异；需要额外镇痛的患者比例；以及不良反应的发生。
共纳入 22 例患者。60 分钟时，NRS 疼痛评分中位数从 6.0 降至 3.0（p < 0.001）。所有患者中，60 分钟时共有 59%的患者 NRS 评分降低 1.5 分。30 分钟和 120 分钟时的中位疼痛评分分别为 4.0（四分位间距（IQR）2.0-5.0）和 2.5（IQR 0.8-3.0）。FICB 后有 7 名患者（31.8%）需要额外使用阿片类镇痛药物。未记录到不良反应。
超声引导下髂筋膜间隙阻滞可使髋部骨折患者的 NRS 疼痛评分在 60 分钟后显著下降，具有临床意义。
该研究在 ISRCTN 数据库（ISRCTN74920258）注册。
