The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients

Archives of Orthopaedic and Trauma Surgery volume 141, pages29–37(2021)Cite this article

Abstract

Objective

Hip fractures are common orthopaedic injuries in the elderly. Opioids can provide peri-operative pain relief in hip fracture patients, but may have side effects. Peripheral nerve blocks such as the fascia iliaca compartment block (FICB) have become an established part of the multimodal analgesic regime administered peri-operatively to hip fracture patients. We compare the efficacy of the continuous infusion FICB (CFICB) on peri-operative pain relief, opioid usage, its associated complications and the short as well as long term rehabilitation status in geriatric hip fractures patients.

Materials and methods

In this retrospective matched case control study, 40 geriatric patients with hip fractures who had received the CFICB from Nov 2014 to April 2016 were matched in a 1:3 ratio with similar patients whom had not received the CFICB from our institution’s hip fracture database of 913 patients.

Results

A total of 157 patients in both the CFICB group (N = 40) and the control group (N = 117) were studied. The post-operative pain scores and the total opioid consumption during the first 3 days in the CFICB group were significantly less than the control group (p < 0.0001, respectively). The systemic complications in the CFICB group were comparable with the control group. The CFICB group had slower rehabilitation at up to 2 weeks but there was no significant difference at 1 year post surgery in terms of function and mobility between the two groups. In both groups, better pre-fracture function was associated with faster short term rehab outcomes in post-operative patients.

Conclusion

The CFICB provides safe and effective post-operative pain relief in geriatric hip fracture patients. Post-operative opioid usage is decreased in older hip fracture patients treated with CFICB. Rehabilitation milestones are slower in the short term, but have no significant difference at 1-year post surgery.

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Funding

This study has not received any funding and the authors have not sought any writing assistance.

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Affiliations

  1. Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    Kumaran Rasappan, Ivan Tjun Huat Chua & Sean Wei Loong Ho

  2. Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hopsital, Singapore, Singapore

    John Boon Lim Tey

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  1. Kumaran Rasappan
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  2. Ivan Tjun Huat Chua
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  3. John Boon Lim Tey
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  4. Sean Wei Loong Ho
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Correspondence to Kumaran Rasappan.

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Rasappan, K., Chua, I.T.H., Tey, J.B.L. et al. The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients. Arch Orthop Trauma Surg 141, 29–37 (2021). https://doi.org/10.1007/s00402-020-03450-2

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Keywords

  • Continuous infusion fascia iliaca compartment block
  • Geriatric hip fractures
  • Pain control
  • Opioid usage
  • Rehabilitation outcomes
  • Functional outcomes