A multidisciplinary network to provide fascia iliaca block for patients with fractured neck of femur

Dr Victoria Ferrier is Regional Anaesthesia Fellow at East Surrey Hospital

Every year, approximately 77,000 hip fractures occur in the UK, accounting for 1.5 million bed days, at an inpatient cost of £0.785 billion. Older patients with hip fracture are at risk of significant morbidity and mortality and there is considerable variation in patient outcomes and management¹.

For patients with fractured neck of femur (NOF), national guidelines in the UK recommend us to consider nerve blocks for preoperative pain relief and to limit opioid dosage². Single-shot or continuous femoral or fascia iliaca nerve blocks may be successfully administered by appropriately trained emergency department, orthopaedic, orthogeriatric and anaesthetic medical staff. These approaches reduce analgesia requirements, improve pain scores and are amenable to ultrasound-guided placement and continuous catheter infusions³.

Since 2007, we at East Surrey Hospital, have been providing an anaesthetic-led fascia iliaca block (FIB) service for patients with fractured NOF. We aim to to perform the block within four hours of the patient presenting to the emergency department and to insert a catheter for a continuous infusion of local anaesthetic. With this service, we have found an opioid sparing effect⁴ and importantly protection against cognitive dysfunction, with greater retention of Abbreviated Mental Test Scores⁵. We have also found the service to be improved when run in conjunction with our orthogeriatrician team⁶.

Do you think this would also benefit patients in your Trust? In order to share our experiences of setting up and running this service, we are holding a Fascia Iliaca Block Service Network Day on the 24th April 2015 at East Surrey Hospital (fibnetwork.eventbrite.co.uk). We look forward to seeing you there!

1. Association of Anaesthetists of Great Britain and Ireland. Management of proximal femoral fractures 2011. Anaesthesia 2012; 67: pages 85-98.
2. National Institute for Health and Care Excellence. Hip fracture: The management of hip fracture in adults. Available at: http://www.nice.org.uk/guidance/cg124. Accessed October 22nd, 2014.
3. Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database of Systematic Reviews 2002; 1: CD001159.
4. Hartopp A, Kelly J, Pocock N, Lawton G, Parrington S. Fascia iliaca blocks in fractured neck of femur: An opioid sparing adjunct? Regional Anaesthesia & Pain Medicine 2014; 39(5): S1.
5. Odor P, Sage F. Protection against cognitive dysfunction in fractured neck of femur patients with admission fascia iliaca blocks. Regional Anaesthesia & Pain Medicine 2014; 39(5): S1.
6. Lucas N, Courtney-Evans N, Sinnot M, Gowland E, Sage F. Reduction in opiate requirement after fractured hip surgery; a quality improvement project. Regional Anaesthesia & Pain Medicine 2014; 39(5): S1.

Photo: St Bartholomew’s Hospital Archives & Museum, Wellcome Images