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Efficacy of Prehospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review

Published online by Cambridge University Press:  01 June 2018

Marcus Hards ,
Andrew Brewer ,
Gareth Bessant  and
Sumitra Lahiri
Marcus Hards*
Affiliation:
Queen Mary University of London, London, UK
Andrew Brewer
Affiliation:
Queen Mary University of London, London, UK
Gareth Bessant
Affiliation:
Queen Mary University of London, London, UK
Sumitra Lahiri
Affiliation:
The Royal London Hospital, London, UK
*
Correspondence: Marcus Hards, MB, ChB Blizard Institute Queen Mary University of London 4 Newark Street Whitechapel, London, E1 2AT E-mail: marcus.hards@sky.com
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Abstract

Introduction

Femoral fractures are painful injuries frequently encountered by prehospital practitioners. Systemic opioids are commonly used to manage the pain after a femoral fracture; however, regional techniques for providing analgesia may provide superior targeted pain relief and reduce opioid requirements. Fascia Iliaca Compartment Block (FICB) has been described as inexpensive and does not require special skills or equipment to perform, giving it the potential to be a suitable prehospital intervention.

Problem

The purpose of this systematic review is to summarize published evidence on the prehospital use of FICB in patients of any age suffering femoral fractures; in particular, to investigate the effects of a prehospital FICB on pain scores and patient satisfaction, and to assess the feasibility and safety of a prehospital FICB, including the success rates, any delays to scene time, and any documented adverse effects.

Methods

A literature search of MEDLINE/PubMED, Embase, OVID, Scopus, the Cochrane Database, and Web of Science was conducted from January 1, 1989 through February 1, 2017. In addition, reference lists of review articles were reviewed and the contents pages of the British Journal of Anaesthesia (The Royal College of Anaesthetists [London, UK]; The College of Anaesthetists of Ireland [Dublin, Ireland]; and The Hong Kong College of Anaesthesiologists [Aberdeen, Hong Kong]) 2016 along with the journal Prehospital Emergency Care (National Association of Emergency Medical Service Physicians [Overland Park, Kansas USA]; National Association of State Emergency Medical Service Officials [Falls Church, Virginia USA]; National Association of Emergency Medical Service Educators [Pittsburgh, Pennsylvania USA]; and the National Association of Emergency Medical Technicians [Clinton, Mississippi USA]) 2016 were hand searched. Each study was evaluated for its quality and its validity and was assigned a level of evidence according to the Oxford Centre for Evidence-Based Medicine (OCEBM; Oxford, UK).

Results

Seven studies involving 699 patients were included (one randomized controlled trial [RCT], four prospective observational studies, one retrospective observational study, and one case report). Pain scores reduced after prehospital FICB across all studies, and some achieved a level of significance to support this. Out of a total of 254 prehospital FICBs, there was a success rate of 90% and only one adverse effect reported. Few studies have investigated the effects of prehospital FICB on patient satisfaction or scene time delays.

Conclusions and Relevance:

The FICB is suitable for use in the prehospital environment for the management of femoral fractures. It has few adverse effects and can be performed with a high success rate by practitioners of any background. Studies suggest that FICB is a useful analgesic technique, although further research is required to investigate its effectiveness compared to systemic opioids.

HardsM, BrewerA, BessantG, LahiriS. Efficacy of Prehospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review. Prehosp Disaster Med. 2018;33(3):299-307.

Keywords

analgesiaEmergency Medical Servicesfemoral fracturesnerve block
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 3 , June 2018 , pp. 299 - 307
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

References

1. Lee, C, Porter, KM. Prehospital management of lower limb fractures. Emerg Med J. 2005;22(9):660-663.Google Scholar
2. Fletcher, AK, Rigby, AS, Heyes, FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003;41(2):227-233.CrossRefGoogle Scholar
3. McClure, R, Turner, C, Peel, N, Spinks, A, Eakin, E, Hughes, K. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev. 2005;(1):CD004441.Google Scholar
4. Mcmanus, JG Jr, Sallee, DR Jr. Pain management in the prehospital environment. Emerg Med Clin North Am. 2005;23(2):415-431.Google Scholar
5. Middleton, PM, Simpson, PM, Sinclair, G, Dobbins, TA, Math, B, Bendall, JC. Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting. Prehosp Emerg Care. 2010;14(4):439-447.Google Scholar
6. Thomas, SH, Shewakramani, S. Prehospital trauma analgesia. J Emerg Med. 2008;35(1):47-57.CrossRefGoogle ScholarPubMed
7. Park, CL, Roberts, DE, Aldington, DJ, Moore, RA. Prehospital analgesia: systematic review of the evidence. J R Army Med Corps. 2010;156(4 Suppl 1):295-300.Google Scholar
8. Jennings, PA, Cameron, P, Bernard, S. Epidemiology of prehospital pain: an opportunity for improvement. Emerg Med J. 2011;28(6):530-531.Google Scholar
9. Ahmadi, A, Bazargan-Hejaze, S, Zadie, ZH, et al. Pain management in trauma: a review study. J Inj Violence Res. 2016;8(2):89-98.Google Scholar
10. Davidson, EM, Ginosar, Y, Avidan, A. Pain management and regional anesthesia in the trauma patient. Curr Opin Anaesthesiol. 2005;18(2):169-174.CrossRefGoogle ScholarPubMed
11. Albrecht, E, Taffe, P, Yersin, B, Schoettker, P, Decosterd, I, Hugli, O. Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study. Br J Anaesth. 2013;110(1):96-106.Google Scholar
12. Holdgate, A, Shepherd, SA, Huckson, S. Patterns of analgesia for fractured neck of femur in Australian emergency departments. Emerg Med Australas. 2010;22(1):3-8.Google Scholar
13. Motov, SM, Khan, AN. Problems and barriers of pain management in the emergency department: are we ever going to get better? J Pain Res. 2008;2:5-11.Google Scholar
14. Sinatra, R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859-1871.Google Scholar
15. Wathen, JE, Gao, D, Merritt, G, Georgopoulos, G, Battan, FK. A randomized controlled trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department. Ann Emerg Med. 2007;50(2):162-171.Google Scholar
16. Schifere, A, Gore, C, Gorove, L, et al. A randomized controlled trial of femoral nerve blockade administered preclinically for pain relief in femoral trauma. Anesth Analg. 2007;105(6):1852-1854.Google Scholar
17. Elkhodair, S, Mortazavi, J, Chester, A, Pereira, M. Single fascia iliaca compartment block for pain relief with fractured neck of femur in the emergency department: a pilot study. Eur J Emerg Med. 2011;18(6):340-343.Google Scholar
18. Høgh, A, Dremstrup, L, Jensen, SS, Lindholt, J. Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture. Strategies Trauma Limb Reconstr. 2008;3(2):65-70.Google Scholar
19. Foss, NB, Kristensen, BB, Bundgaard, M, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology. 2007;106(4):773-778.CrossRefGoogle ScholarPubMed
20. Beaudoin, FL, Haran, JP, Liebmann, O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20(6):584-591.Google Scholar
21. Christos, SC, Chiampas, G, Offman, R, Rifenburg, R. Ultrasound-guided three-in-one nerve block for femur fractures. West J Emerg Med. 2010;11(4):310-313.Google Scholar
22. Dalens, B, Vanneuville, G, Tanguy, A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg. 1989;69(6):705-713.Google Scholar
23. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Br Medical J. 2009;339:b2535.CrossRefGoogle ScholarPubMed
24. Smith, E, McDonald, S, Wasiak, J, Jennings, P, MacPherson, C, Archer, F. The development of a prehospital search filter for the Cochrane Library. JEPHC. 2004;2(1-2):Item No. CC990071.Google Scholar
25. Oxford Centre for Evidence-Based Medicine. Levels of evidence (March 2009). http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed June 31, 2017.Google Scholar
26. Higgins, JPT, Green, S. (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Chapter 8: Assessing risk of bias in included studies. London, UK: The Cochrane Collaboration; 2011.Google Scholar
27. Cochrane Consumers and Communication Review Group. Data Extraction Template for Included Studies - Version 1.7. June 2016. http://cccrg.cochrane.org/author-resources. Accessed June 31, 2017.Google Scholar
28. Levine, AC, Teicher, C, Aluisio, AR, et al. Regional Anesthesia for Painful Injuries after Disasters (RAPID): study protocol for a randomized controlled trial. TRIALS. 2016;17:542.Google Scholar
29. Lefort, H, Mendibil, A, Romanat, PE, Tourtier, JP. Anesthésie locorégionale préhospitalière: le bloc iliofascial. Ann Fr Med Urgenc. 2013;3(6):363-366.Google Scholar
30. Kosiński, S. Analgesia with the use of regional block techniques in mountain rescue. Anestezjologia Intensywna Terapia. 2006;38(2):81-83.Google Scholar
31. Gros, T, Hatterer, E, Plasse, C, De La Coussaye, JE. Bloc iliofascial en médecine préhospitalière. Ann Fr Anesth Reanim. 1999;18(2):282-283.CrossRefGoogle Scholar
32. Barker, R, Schiferer, A, Gore, C, et al. Femoral nerve blockade administered preclinically for pain relief in severe knee trauma is more feasible and effective than intravenous metamizole: a randomized controlled trial. J Trauma. 2008;64(6):1535-1538.Google Scholar
33. McRae, PJ, Bendall, JC, Madigan, V, Middleton, PM. Paramedic-performed Fascia Iiliaca Compartment Block for femoral fractures: a controlled trial. J Emerg Med. 2015;48(5):581-589.CrossRefGoogle ScholarPubMed
34. Dochez, E, van Geffen, GJ, Bruhn, J, Hoogerwerf, N, van de Pas, H, Scheffer, G. Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study. Scand J Trauma Resusc Emerg Med. 2014;22:38.Google Scholar
35. Gros, T, Viel, E, Ripart, J, Delire, V, Eledjam, JJ, Sebbane, M. Bloc fémoral en analgésie préhospitalière pour traumatisme du membre inférieur. Enquête de pratique observationnelle sur 107 cas. Prehospital analgesia with femoral nerve block following lower extremity injury. A 107 cases survey. Ann Fr Anesth Reanim 2012;31(11):846-849.Google Scholar
36. Lansdown, A, Lupton, T, Reid, C. Regional anesthesia practices for isolated femoral shaft fractures in a Helicopter Emergency Medical Service (HEMS) (Poster). Emerg Med Aus. 2011;23:s34.Google Scholar
37. Minville, V, Gozlan, C, Asehnoune, K, Zetlaoui, P, Chassery, C, Benhamou, D. Fascia-iliaca compartment block for femoral bone fracture in prehospital medicine in a 6-yr-old child. Eur J Anaesth. 2006;23(8):715-716.Google Scholar
38. Gozlan, C, Minville, V, Asehnoune, K, Raynal, P, Zetlaoui, P, Benhamou, D. Fascia iliaca block for femoral bone fractures in prehospital medicine. Ann Fr Anesth Reanim. 2005;24(6):617-620.Google Scholar
39. Lopez, S, Gros, T, Bernard, N, Plasse, C, Capdevila, M. Fascia Iliaca Compartment Block for femoral bone fractures in prehospital care. Reg Anesth Pain Med. 2003;28(3):203-207.Google Scholar
40. Jeng, CL, Torrillo, TM, Rosenblatt, MA. Complications of peripheral nerve blocks. Br J Anaesth. 2010;105(Suppl 1):i97-i107.CrossRefGoogle ScholarPubMed
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