Abstract
Purpose of Review
Over 300,000 patients are hospitalized annually following hip fractures in the USA. Many patients experienced inadequate analgesia. We will review the perioperative effects of the fascia iliaca compartment block (FICB) in hip fracture patients.
Recent Findings
FICB by injecting local anesthetics beneath the fascia iliaca results in significant pain relief in hip fractures. Neuropathies and vascular injuries are almost unlikely. Single-shot FICB is faster to place, yet providing about 8 h of analgesia when bupivacaine is used. Continuous FICB provides prolonged titratable analgesia, improved patient satisfaction, and leads to faster hospital discharge. FICB reduces opioid consumption, decreases morbidity and mortality, reduces hospital stay, reduces delirium, and improves satisfaction.
Summary
FICB should form part of a multimodal analgesic regime, in the context of a multidisciplinary approach to the management of hip fracture patients. More clinical investigations are needed to validate the long-term outcome benefits of FICB in hip fracture patients.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hip fractures among older adults [Internet]. Atlanta: Centers for Disease Control; [updated September 20, 2016; cited September 7, 2020]. Available from: https://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html.
Gerson LW, Emond JA, Camargo CA Jr. US emergency department visits for hip fracture, 1992-2000. Eur J Emerg Med. 2004;11(6):323–8. https://doi.org/10.1097/00063110-200412000-00005.
• Griffiths R, Alper J, Beckingsale A, et al. Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2012;67(1):85–98. https://doi.org/10.1111/j.1365-2044.2011.06957.xThis article provides an excellent summary of perioperative management of patients with hip/femoral fracture, emphasizing a protocol-driven, fast-track admission of hip fracture patients and surgical repair of hip fractures within 48 h.
Griffiths R, Rasmussen LS. Delirium in hip fracture patients. Acta Anaesthesiol Scand. 2010;54(6):661–2. https://doi.org/10.1111/j.1399-6576.2010.02242.x.
Stewart NA, Chantrey J, Blankley SJ, Boulton C, Moran CG. Predictors of 5 year survival following hip fracture. Injury. 2011;42(11):1253–6. https://doi.org/10.1016/j.injury.2010.12.008.
Malafarina V, Reginster JY, Cabrerizo S, et al. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 2018;10(5). https://doi.org/10.3390/nu10050555.
Kelly-Pettersson P, Samuelsson B, Unbeck M, et al. The influence of depression on patient-reported outcomes for hip-fracture patients 1 year after surgery: a prospective cohort study. Aging Clin Exp Res. 2020;32(2):247–55. https://doi.org/10.1007/s40520-019-01207-5.
Park HY, Kim S, Sohn HS, Kwon JW. The association between polypharmacy and hip fracture in osteoporotic women: a nested case-control study in South Korea. Clin Drug Investig. 2019;39(1):63–71. https://doi.org/10.1007/s40261-018-0716-3.
Lee BH, Kumar KK, Wu EC, et al. Role of regional anesthesia and analgesia in the opioid epidemic. Reg Anesth Pain Med. 2019 Feb 13:rapm-2018-100102. https://doi.org/10.1136/rapm-2018-100102.10.
Baboli KM, Liu H, Poggio JL. Opioid-free postoperative analgesia: is it feasible? Curr Probl Surg. 2020;57(7):100795. https://doi.org/10.1016/j.cpsurg.2020.100794.
Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD. Use of regional anesthesia techniques: analysis of institutional enhanced recovery after surgery protocols for colorectal surgery. J Laparoendosc Adv Surg Tech A. 2017;27(9):898–902. https://doi.org/10.1089/lap.2017.0339.
Bugada D, Bellini V, Lorini LF, Mariano ER. Update on selective regional analgesia for hip surgery patients. Anesthesiol Clin. 2018;36(3):403–15. https://doi.org/10.1016/j.anclin.2018.04.001.
Johnson RL, Kopp SL, Kessler J, et al. Peripheral nerve blocks and ultrasound guidance for regional anesthesia. In: Gropper MA, editor. Miller’s anesthesia. 9th ed. Philadelphia: Elsevier; 2019. p. 1450–79.
Birnbaum K, Prescher A, Hessler S, et al. The sensory innervation of the hip joint—an anatomical study. Surg Radiol Anat. 1997;19(6):371–5. https://doi.org/10.1007/BF01628504.
Walji AH, Tsui BCH. Clinical anatomy of the lumbar plexus. In: Tsui BCH, Suresh S, editors. Pediatric atlas of ultrasound- and nerve stimulation-guided regional anesthesia. New York: Springer; 2016. p. 167.
•• Desmet M, Balocco AL, Van Belleghem V. Fascia iliaca compartment blocks: different techniques and review of the literature. Best Pract Res Clin Anaesthesiol. 2019;33(1):57–66. https://doi.org/10.1016/j.bpa.2019.03.004This article provides a thorough review of different techniques for fascia iliaca compartment block.
Singh M, Awad IT, McCartney CJL. Ultrasound-guided nerve blocks of the lower limb. In: Narouze SN, editor. Atlas of ultrasound-guided procedures in interventional pain management. 2nd ed. New York: Springer. p. 203.
Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia: the “3-in-1 block”. Anesth Analg. 1973;52(6):989–96.
Dalens B. Regional anesthesia in children. Anesth Analg. 1989;68(5):654–72.
Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubenovitch J, d′Athis F. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg. 1998;86(5):1039–44. https://doi.org/10.1097/00000539-199805000-00025.
Dolan J, Williams A, Murney E, et al. Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Reg Anesth Pain Med. 2008;33(6):526–31. https://doi.org/10.1016/j.rapm.2008.03.008.
Wilson SH, Uskova A. Peripheral nerve blocks for the lower extremity. In: Kaye AD, Urman RD, Vadivelu N, editors. Essentials of regional anesthesia. 2 ed. New York: Springer; 2018. p. 275.
Awad IT, Chan V. Ultrasound imaging of peripheral nerves: a need for a new trend. Reg Anesth Pain Med. 2005;30(4):321–3. https://doi.org/10.1016/j.rapm.2005.05.011.
Liu SS. Evidence basis for ultrasound-guided block characteristics onset, quality, and duration. Reg Anesth Pain Med. 2016;41(2):205–20. https://doi.org/10.1097/AAP.0000000000000141.
Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF, Cochrane Anaesthesia Group. Ultrasound guidance for upper and lower limb blocks. Cochrane Database Syst Rev. 2015;9:CD006459. https://doi.org/10.1002/14651858.CD006459.pub3.
Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011;66(4):300–5. https://doi.org/10.1111/j.1365-2044.2011.06628.x.
Desmet M, Vermeylen K, Van Herreweghe I, et al. A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty. Reg Anesth Pain Med. 2017;42(3):327–33. https://doi.org/10.1097/AAP.0000000000000543.
Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, et al. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Reg Anesth Pain Med. 2019;44:483–91. https://doi.org/10.1136/rapm-2018-100092.
Vermeylen K, Soetens F, Leunen I, Hadzic A, van Boxtael S, Pomés J, et al. The effect of the volume of supra-inguinal injected solution on the spread of the injectate under the fascia iliaca: a preliminary study. J Anesth. 2018;32(6):908–13. https://doi.org/10.1007/s00540-018-2558-9.
Stevens M, Harrison G, McGrail M. A modified fascia iliaca compartment block has significant morphine-sparing effect after total hip arthroplasty. Anaesth Intensive Care. 2007;35(6):949–52. https://doi.org/10.1177/0310057X0703500615.
Blackford D, Westhoffen P. Accidental bladder puncture: a complication of a modified fascia iliaca block. Anaesth Intensive Care. 2009;37(1):140–1.
•• Jones MR, Novitch MB, Hall OM, et al. Fascia iliaca block, history, technique, and efficacy in clinical practice. Best Pract Res Clin Anaesthesiol. 2019;33(4):407–13. https://doi.org/10.1016/j.bpa.2019.07.011This article thoroughly reviewed the history, technique, and efficacy of fascia iliaca compartment block and emphasized that ultrasound-guided technique is benificial.
Jeng CL, Torrillo TM, Rosenblatt MA. Complications of peripheral nerve blocks. Br J Anaesth. 2010;105(Suppl 1):i97–107. https://doi.org/10.1093/bja/aeq273.
Fadhlillah F, Chan D, Pelosi P, et al. Systematic review and meta-analysis of single injection fascia iliaca blocks in the peri-operative management of patients with hip fractures. Minerva Anestesiol. 2019;85(11):1211–8. https://doi.org/10.23736/S0375-9393.19.13535-3.
Behrends M, Yap EN, Zhang AL, Kolodzie K, Kinjo S, Harbell MW, et al. Preoperative fascia iliaca block does not improve analgesia after arthroscopic hip surgery, but causes quadriceps muscles weakness: a randomized, double-blind trial. Anesthesiology. 2018;129(3):536–43. https://doi.org/10.1097/ALN.0000000000002321.
Bomberg H, Wetjen L, Wagenpfeil S, Schöpe J, Kessler P, Wulf H, et al. Risks and benefits of ultrasound, nerve stimulation, and their combination for guiding peripheral nerve blocks: a retrospective registry analysis. Anesth Analg. 2018;127(4):1035–43. https://doi.org/10.1213/ANE.0000000000003480.
Elkhodair S, Mortazavi J, Chester A, Pereira M. Single fascia iliaca compartment block for pain relief in patients with fractured neck of femur in the emergency department: a pilot study. Eur J Emerg Med. 2011;18(6):340–3. https://doi.org/10.1097/MEJ.0b013e32834533dd.
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. https://doi.org/10.1007/s11751-008-0037-9.
Hasan SS, Rolf RH, Sympson AN, Eten K, Elsass TR. Single-shot versus continuous interscalene block for postoperative pain control after shoulder arthroplasty: a prospective randomized clinical trial. J Am Acad Orthop Surg Glob Res Rev. 2019;3(6):e014. https://doi.org/10.5435/JAAOSGlobal-D-19-00014.
Steenberg J, Møller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018;120(6):1368–80. https://doi.org/10.1016/j.bja.2017.12.042.
Dada O, Gonzalez Zacarias A, Ongaigui C, et al. Does rebound pain after peripheral nerve block for orthopedic surgery impact postoperative analgesia and opioid consumption? A narrative review. Int J Environ Res Public Health. 2019;16(18). https://doi.org/10.3390/ijerph16183257.
Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904–25. https://doi.org/10.1213/ANE.0b013e3182285e01.
Fredrickson MJ, Leightley P, Wong A, Chaddock M, Abeysekera A, Frampton C. An analysis of 1505 consecutive patients receiving continuous interscalene analgesia at home: a multicentre prospective safety study. Anaesthesia. 2016;71(4):373–9. https://doi.org/10.1111/anae.13385.
Hogan Q. Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med. 2002;27(2):150–6. https://doi.org/10.1053/rapm.2002.29748.
George RB, Allen TK, Habib AS. Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesth Analg. 2013;116(1):133–44. https://doi.org/10.1213/ANE.0b013e3182713b26.
Hillegass MG, Field LC, Stewart SR, Borckardt JJ, Dong L, Kotlowski PE, et al. The efficacy of automated intermittent boluses for continuous femoral nerve block: a prospective, randomized comparison to continuous infusions. J Clin Anesth. 2013;25(4):281–8. https://doi.org/10.1016/j.jclinane.2012.11.015.
Wang N, Li M, Geng J, Chen XL, Guo XY. A clinical study of the efficacy of automated intermittent boluses for continuous fascia iliaca block. Zhonghua Yi Xue Za Zhi. 2016;96(22):1750–4. https://doi.org/10.3760/cma.j.issn.0376-2491.2016.22.008.
Rasmussen SB, Saied NN, Bowens C, et al. Duration of upper and lower extremity peripheral nerve blockade is prolonged with dexamethasone when added to ropivacaine: a retrospective database analysis. Pain Med. 2013;14(8):1239–47. https://doi.org/10.1111/pme.12150.
Pehora C, Pearson AM, Kaushal A, et al. Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database Syst Rev. 2017;11:CD011770. https://doi.org/10.1002/14651858.CD011770.pub2.
American Geriatrics Society 2019. Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–94. https://doi.org/10.1111/jgs.15767.
Kirksey MA, Haskins SC, Cheng J, Liu SS. Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One. 2015;10(9):e0137312. https://doi.org/10.1371/journal.pone.0137312.
Guay J, Parker MJ, Griffiths R, Kopp S, Cochrane Anaesthesia Group. Peripheral nerve blocks for hip fractures. Cochrane Database Syst Rev. 2017;5:CD001159. https://doi.org/10.1002/14651858.CD001159.pub2.
Rasappan K, Chua ITH, Tey JBL, Ho SWL. The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients. Arch Orthop Trauma Surg. 2020;141:29–37. https://doi.org/10.1007/s00402-020-03450-2.
Morrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, et al. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial. J Am Geriatr Soc. 2016;64(12):2433–9. https://doi.org/10.1111/jgs.14386.
Pasquier M, Taffé P, Hugli O, Borens O, Kirkham KR, Albrecht E. Fascia iliaca block in the emergency department for hip fracture: a randomized, controlled, double-blind trial. BMC Geriatr. 2019;19(1):180. https://doi.org/10.1186/s12877-019-1193-0.
Yamamoto N, Sakura S, Noda T, Nishiyama A, Dan’ura T, Matsui Y, et al. Comparison of the postoperative analgesic efficacies of intravenous acetaminophen and fascia iliaca compartment block in hip fracture surgery: a randomised controlled trial. Injury. 2019;50(10):1689–93. https://doi.org/10.1016/j.injury.2019.03.008.
Thompson J, Long M, Rogers E, Pesso R, Galos D, Dengenis RC, et al. Fascia iliaca block decreases hip fracture postoperative opioid consumption: a prospective randomized controlled trial. J Orthop Trauma. 2020;34(1):49–54. https://doi.org/10.1097/BOT.0000000000001634.
Bang S, Chung J, Jeong J, Bak H, Kim D. Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty: a prospective, randomized trial. Medicine (Baltimore). 2016;95(39):e5018. https://doi.org/10.1097/MD.0000000000005018.
Lees D, Harrison WD, Ankers T, A’Court J, Marriott A, Shipsey D, et al. Fascia iliaca compartment block for hip fractures: experience of integrating a new protocol across two hospital sites. Eur J Emerg Med. 2016;23(1):12–8. https://doi.org/10.1097/MEJ.0000000000000167.
Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthop Traumatol. 2009;10(3):127–33. https://doi.org/10.1007/s10195-009-0062-6.
Diakomi M, Papaioannou M, Mela A, et al. Preoperative fascia iliaca compartment block for positioning patients with hip fractures for central nervous blockade: a randomized trial. Reg Anesth Pain Med. 2014;39(5):394–8. https://doi.org/10.1097/AAP.0000000000000133.
Bardram L, Funch-Jensen P, Jensen P, Kehlet H, Crawford ME. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345:763–4. https://doi.org/10.1016/S0140-6736(95)90643-6.
ERAS Society Stockholm: 2016 [updated September 7, 2020; cited September 7, 2020]. Available from: erassociety.org.
Macfie D, Zadeh RA, Andrews M, Crowson J, Macfie J. Perioperative multimodal optimisation in patients undergoing surgery for fractured neck of femur. Surgeon. 2012;10(2):90–4. https://doi.org/10.1016/j.surge.2011.01.006.
Reguant F, Arnau A, Lorente JV, Maestro L, Bosch J. Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture. J Clin Anesth. 2019;53:11–9. https://doi.org/10.1016/j.jclinane.2018.09.029.
Soffin EM, Gibbons MM, Wick EC, Kates SL, Cannesson M, Scott MJ, et al. Evidence review conducted for the agency for healthcare research and quality safety program for improving surgical care and recovery: focus on anesthesiology for hip fracture surgery. Anesth Analg. 2019;128(6):1107–17. https://doi.org/10.1213/ANE.0000000000003925.
Hong HK, Ma Y. The efficacy of fascia iliaca compartment block for pain control after hip fracture: a meta-analysis. Medicine (Baltimore). 2019;98(28):e16157. https://doi.org/10.1097/MD.0000000000016157.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no relevant conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Acute Pain Medicine
Rights and permissions
About this article
Cite this article
Verbeek, T., Adhikary, S., Urman, R. et al. The Application of Fascia Iliaca Compartment Block for Acute Pain Control of Hip Fracture and Surgery. Curr Pain Headache Rep 25, 22 (2021). https://doi.org/10.1007/s11916-021-00940-9
Accepted:
Published:
DOI: https://doi.org/10.1007/s11916-021-00940-9