Effect of ultrasound-guided fascia iliaca compartment block on pain management in hip fracture patients: A double-blind placebo-controlled randomized clinical trial

Abstract

Background: Evidence for emergency department (ED) ultrasound-guided fascia iliaca compartment block (UG-FICB) in hip-fracture analgesia is limited.

Methods: In this double-blind, placebo-controlled, randomized clinical trial in a Dutch ED, adults with a radiologically confirmed hip fracture were randomized 1:1 to weight-adjusted levobupivacaine UG-FICB or volume matched saline. All participants were granted access to a patient-controlled analgesia (PCA) pump with morphine for pain control. The primary outcome was cumulative morphine demand during the first 6 hours. Secondary outcomes were pain scores, time to first morphine demand, opioid-free period, and adverse events.

Results: Fifty-five participants were randomized (January 28, 2019-February 17, 2020; 2 were excluded because surgery occurred within an hour after UG-FICB, leaving 53 for analysis (levobupivacaine 29, placebo 24). Median 6 hours morphine demand was 3 mg (1-6 with levobupivacaine and 3 mg (2-6) with placebo (P = .46). Time to first morphine request was shorter on placebo (HR 1.87, 95% confidence interval (CI): 1.01-3.45) and levobupivacaine increased the opioid-free proportion (24% vs 4). Pain at 1 hour was lower with levobupivacaine (mean difference was -1.5 NRS units, P = .02); thereafter differences were non-significant. The following adverse events occurred: nausea/vomiting 3, injection pain 1, delirium 1, drowsiness 1). Recruitment stopped early because of COVID-19 pandemic.

Conclusions: Single-shot UG-FICB did not reduce 6 hours morphine consumption, but delayed first opioid use and allowed one quarter of patients to remain opioid-free. Larger adequately powered trials are required.

Keywords: analgesia; emergency service; hip fractures; levobupivacaine; nerve block; opioid analgesics; pain measurement; patient-controlled; randomized controlled trials as topic.