I’ve been on a bit of a rant lately about how the ED sets the course for the remainder of the inpatient stay. The most recent eye-catching paper to come across my QxMD feed reinforces this.
326 patients with an acute hip fracture who received a fascia iliaca compartment block in the ED were compared to 100 patients who had received “standard of care” – IV, IM, or oral meds at the teams discretion. Not surprisingly, there was a reduction in pain score and opiate requirement with the iliaca block. Most surprisingly was the 9.9 to 15 day difference in length of stay, as well as inpatient mortality of 5.5% vs 15% in the iliaca nerve block vs standard treatment, respectively. The authors admit there may be confounding factors at play, however, these are striking numbers and the largest study of a nerve block I have seen in the acute setting, and these are hard to argue with. For those of you wondering, this study then retrospectively looked at 1586 patients that were given an iliac block at their participating institutes, and noted only 2 (TWO) incidences of systemic anesthetic toxicity.
Now, given the above, lets compare iliaca to femoral nerve blocks. A previous study of 110 patients showed a statistically significant pain improvement with the femoral nerve block vs the iliaca block, and that the femoral block arm required less parenteral narcotics.
If you have not yet done a sono guided femoral nerve block – try it out! (https://www.youtube.com/watch?v=5ht_N8j2KL8) Its pretty easy, and takes about five minutes to do the procedure, plus a few more for set up. If admin gives you grief, its hard to argue with improved pain control, LOS & mortality.