Impact of Fascia Iliaca Block on Pain, Opioid Consumption, and Ambulation for Patients With Hip Fractures - A Prospective, Randomized Study

J Orthop Trauma. 2020 Apr 30. doi: 10.1097/BOT.0000000000001795. Online ahead of print.

Abstract

Objectives: To determine the effect of the fascia iliaca block (FIB) on patients undergoing surgery for hip fractures.

Design: Prospective, randomized controlled trial SETTING:: Level I trauma center.

Patients/participants: Patients (N = 97) undergoing surgery for hip fractures were prospectively randomized to receive either a perioperative FIB (FIB group) or receive no block (control group) from February 2018 to April 2019.

Main outcome measures: visual analog score (VAS), morphine milligram equivalents (MME), post-operative ambulatory distance RESULTS:: Fifty-seven patients were randomized to the FIB group and 40 patients were randomized to the control group. Eighteen patients crossed over from the FIB to the control group, and twelve crossed from the control to the FIB group. In the intent to treat analysis, demographic data, mechanism of injury, radiographic fracture classification, and surgical procedure were similar between the two groups. The FIB group consumed fewer MMEs prior to surgery (13 versus 17, p = 0.04), had a trend toward improved VAS on postop day (POD) 2 (0 versus 2 p = 0.06), and walked a farther distance POD 2 (25' versus 2 ' p = 0.09). A greater proportion of the FIB group was discharged home (50.9% versus 32.5%, p = 0.05). There were no differences in opioid-related, block-related, or medical complications between groups. In the as treated and per protocol analyses there were no significant differences.

Conclusions: A single perioperative FIB for patients with hip fractures undergoing surgery may decrease opioid consumption and increase the likelihood that a patient is discharged home.

Level of evidence: Level II, Therapeutic.