AbstractObjectives & Background
Fascia iliaca compartment block (FICB) provides excellent pain relief for neck of femur fractures (NOFF). It can be given safely using an ultrasound guided technique in the Emergency Department (ED). At Salford Royal NHS Foundation Trust (SRFT) FICB was introduced to the analgesic pathway for hip fracture management in 2012, in combination with paracetamol and then opioids third line. The aim of this audit is to further investigate the effectiveness of FICB and determine whether the use of FICB can reduce hospital stay, discharge destination and in-hospital complication rates.Methods
Data was collected retrospectively for all patients attending SRFT ED with a NOFF from 1 August 2011– 31 January 2012 and 1 August 2014–31 January 2015. 136 of 198 patients were included in the study. Patients were omitted if they were later found not to have NOFF, if they were treated non-surgically, or if any scanned notes from the ED or theatre were not available. Any patient receiving an alternative nerve block was also omitted from the study. Patient demographics and whether or not they received a FICB in the ED and in theatre were recorded. The length of stay in hospital, discharge destination, any in-hospital complications and 7 and 30 day mortality were also recorded for each patient.Results
The results showed that significantly more patients were unable to go immediately home after their acute hospital admission when they did not have a FICB in the ED or theatre, compared to when they did (Pearsons Chi square test, p=0.028). The biggest impact on patient destination was determined by receiving FICB in theatre (Pearsons Chi square test, p=0.006). Giving FICB during hospital stay had no significant influence on length of stay (Mann Whitney U test, p=0.507) or in-hospital complication rates (Pearson Chi square test, p=0.117).Conclusion
Giving patients a FICB increases their chances of returning home at discharge. Without it patients are more likely to be discharged to intermediate care or residential and nursing homes. FICB had no effect on length of stay or in-hospital complications. We recommend that all patients be offered a FICB in the ED.