Fascia Iliaca Block Decreases Hip Fracture Postoperative Opioid Consumption: A Prospective Randomized Controlled Trial.

Abstract

OBJECTIVES\nTo determine the efficacy of a preoperative Fasica Iliaca Compartment Block (FICB) in decreasing postoperative pain and improving functional recovery following hip fracture surgery.\n\n\nDESIGN\nRandomized prospective level 1 therapeutic SETTING:: Academic level 1 trauma center PATIENTS:: Geriatric patients with fractures of the proximal femur (neck, intertrochanteric or subtrochanteric regions) were prospectively randomized into an experimental (A) or control (B) groups. 47 patients met inclusion criteria, 23 randomized to the experimental group and 24 to the control group.\n\n\nINTERVENTION\nPatients randomized to the experimental group received an ultrasound guided fascia iliaca compartment block administered by a board certified anesthesiologist immediately prior to the initiation of anesthesia.\n\n\nMAIN OUTCOME MEASUREMENTS\nPrimary outcome measure was postoperative pain medication consumption until postoperative day three. Secondary outcomes included functional recovery and a study-specific patient-reported satisfaction survey assessed on postoperative day three.\n\n\nRESULTS\nThere was no significant difference in consumption of Acetaminophen for mild pain, Tramadol for moderate pain, or functional recovery between the two groups. There was a statistically significant decrease in Morphine consumption (0.4mg vs. 19.4mg, p=0.05) and increase in patient-reported satisfaction (31%, p=0.01).\n\n\nCONCLUSIONS\nPreoperative FICB significantly decreases postoperative opioid consumption while improving patient satisfaction. We recommend the integration of this safe and efficacious modality into institutional geriatric hip fracture protocols as an adjunctive pain control strategy.