Ultrasound-guided fascia iliaca compartment block for pain control in peritrochanteric fractures in the emergency department: A prospective observational study.

OBJECTIVE

Hip fractures are associated with moderate-to-severe pain, which is frequently managed inadequately in emergency departments (EDs). This study set out to evaluate the analgesic effectiveness of an ultrasound-guided fascia iliaca compartment block (FIB) administered by emergency physicians to patients with peritrochanteric hip fractures.

METHODS

A prospective observational study was conducted on 142 patients presenting to the ED with peritrochanteric hip fractures and a baseline Visual Analog Scale (VAS) score of 4 or higher. An ultrasound-guided FIB was performed, and pain scores were assessed at baseline, 1, 2, and 6 h. The primary outcome was ≥ 50% reduction in VAS. The secondary outcomes included need for rescue analgesia (intravenous fentanyl 1 μg/kg) and adverse events. Data were nonnormally distributed and analyzed using the Friedman test with Bonferroni-adjusted pairwise comparisons. Effect size and 95% confidence intervals (CIs) were calculated.

RESULTS

The median VAS decreased from 7 (interquartile range [IQR]: 6-8) at baseline to 3 (IQR: 2-3) at 1 h, 2 (IQR: 1-2) at 2 h, and 1 (IQR: 1-2) at 6 h (P < 0.001, Friedman test; effect size r = 0.83). A successful block (≥50% VAS reduction) was achieved in 97.2% of patients (95% CI: 92.9%-99.1%). Only 4 (2.8%) patients required rescue fentanyl. No complications, including local anesthetic systemic toxicity or delirium, were recorded.

CONCLUSION

Ultrasound-guided FIB administered by trained emergency physicians is associated with significant and sustained analgesia in patients with peritrochanteric hip fractures, with minimal need for rescue opioids and no observed adverse events.