Department of Hospital Medicine, Marshfield Medical Center, Marshfield, Wisconsin.
Department of Emergency Medicine, Marshfield Medical Center, Marshfield, Wisconsin.
J Emerg Med. 2022 Jul;63(1):1-9. doi: 10.1016/j.jemermed.2022.04.018. Epub 2022 Aug 4.
Fascia iliaca compartment block (FICB) has become a keystone technique for acute pain management in patients with hip and proximal femur fractures.
To demonstrate that administering FICB preoperatively to patients with hip or proximal femur fractures in the emergency department (ED) is likely to reduce opioid use and related complications, and to decrease hospital length of stay (LOS).
An unblinded study of adult patients with hip and proximal femur fractures who consented to receive an FICB with 30 cc of bupivacaine with epinephrine administered in the ED. We compared this group with a contemporaneous group of controls who only received systemic opioids. Over the course of approximately 6 months, main outcome measured between the two groups was amount of morphine equivalents given from block administration until 8 h after. We also compared complications such as delirium, constipation, and bleeding rates (oozing from injection site or hematoma formation).
A total of 166 patients with hip and proximal femur fractures from August 12, 2018 to April 25, 2021; 81 received FICB plus systemic opioids, and 85 received only systemic opioids. Among the FICB group, morphine equivalents were reduced by 0.6 mg/h with no significant difference in LOS. A statistically significant difference in opioid-related adverse outcomes was found between the anticoagulated group vs. the no anticoagulation group.
FICB is a safe and effective preoperative technique for initial pain management in patients with hip and proximal femur fractures, as it can also be used with additional systemic opioids. FICB administration may reduce systemic opioid use preoperatively, thus reducing opioid-related adverse effects with no significant impact on hospital LOS.
股外侧肌间隙阻滞（FICB）已成为髋部和股骨近端骨折患者急性疼痛管理的关键技术。
证明在急诊科（ED）对髋部或股骨近端骨折患者进行术前 FICB 给药可能会减少阿片类药物的使用和相关并发症，并缩短住院时间（ LOS ）。
对同意在 ED 接受布比卡因加肾上腺素 30cc 股外侧肌间隙阻滞的髋部和股骨近端骨折成年患者进行非盲研究。我们将该组与仅接受全身阿片类药物的同期对照组进行比较。在大约 6 个月的时间内，两组之间的主要观察结果是从阻滞给药到 8 小时后给予的吗啡等效物量。我们还比较了并发症，如谵妄、便秘和出血率（从注射部位渗出或血肿形成）。
2018 年 8 月 12 日至 2021 年 4 月 25 日共收治髋部和股骨近端骨折患者 166 例，其中 81 例接受 FICB 加全身阿片类药物，85 例仅接受全身阿片类药物。在 FICB 组中，吗啡等效物减少了 0.6mg/h ， LOS 无显著差异。在抗凝组与非抗凝组之间发现了与阿片类药物相关的不良结局存在统计学显著差异。
FICB 是髋部和股骨近端骨折患者初始疼痛管理的一种安全有效的术前技术，因为它还可以与额外的全身阿片类药物一起使用。FICB 给药可减少术前全身阿片类药物的使用，从而减少与阿片类药物相关的不良反应，而对住院 LOS 无显著影响。
