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Should Fascia Iliaca Compartment Blocks be used in the pre-hospital setting for the management of femoral-fractures? A literature review

Posted on August 8, 2019 by Holly Hambleton

Evidence Reviews

During the final year of their Paramedic Science (BSc Hons) course at Oxford Brookes University, students carry out a literature review and critical appraisal of a topic relevant to their future practice.  This blog presents the abstract of a literature review on the ‘Use of Fascia Iliaca Compartment Blocks in a pre-hospital setting for femoral fractures‘.   Other Paramedic topic blogs can be found here.


Aim

This literature review will attempt to explore the pre-hospital use, benefits and feasibility of Fascia Iliaca Compartment Blocks (FICBs) for patients with femoral fractures. Particularly studying the performance of paramedics in FICBs.

Background

Femoral fractures are common in the pre-hospital setting and are increasing in incidence, mostly due to the ageing population. Current pre-hospital analgesia has been identified as suboptimal and is thought to be associated with high mortality, morbidity and prevalence of short-term and long-term adverse effects in femoral-fracture patients. This potentially creates a gap for alternative management to be considered if evidenced as superior to the current management.

Methods

Secondary data was searched comprehensively on the healthcare databases; PubMed, CINHAL and The Cochrane Library via the Oxford Brookes University library database search. The PRISMA Flow Chart (2009) was then used to screen and assess the eligibility of the literature which were then critically appraised using the CASP and The Centre for Evidence-Based Medicine Levels of Evidence tools. Further evaluation of the evidence was undergone using thematic analysis. Six papers were identified for use.

Results

All six papers demonstrated a significant decrease in pain score with FICBs and one study demonstrated a satisfaction rate of nine out of ten, demonstrating its adequacy. FICBs superiority was also demonstrated with pain scores being 28% (P=0.025) lower than with opiate use.  Minimal to no adverse effects were reported with FICBs and five studies demonstrated high success rates spanning from 80-90%.

Conclusion

Paramedics are capable of performing FICBs safely and competently in the pre-hospital setting, supported by high success rates. The procedure also evidentially provides a superior analgesic effect, in comparison to morphine, with minimal to no adverse effects. All evidence supports FICBs being safe, feasible and advantageous in the pre-hospital setting. However, further evidence and research is needed to build a stronger foundation to introduce FICBs into the guidelines for paramedics practice.


References:

Bulger, J, K., Brown, A., Evans, B, A., Fegan, G., Ford, S., Guy, K., Jones, S., Keen, L., Khanom, A., Pallister, I., Rees, N., Russell, I, T., Seagrove, A, C., Snooks, H, A., (2017) Rapid analgesia for pre-hospital hip disruption (RAPID): protocol for feasibility study of randomised control trial. Pilot and Feasibility Studies, 3.

Dochez, E., Van Feffen, G, J., Bruhn, J., Hoogerwerf, N., Van De Pas, H., Scheffer, G., (2014) Pre-hospital administered fascia Iliaca compartment block by emergency medical service nurses, a feasibility study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23.

Gozlan, C., Minville, V., Asehnounce, K., Raynal, P., Zetlaoui, P., Benhamou, D., (2005) Fascia Iliaca block for femoral bone fractures in pre-hospital medicine. Annales Francaises d’anethesie et de reanimation, 24, pp 617-620.

Hards, M., Brewer, A., Bessant, G., Lahiri, S., (2018) Efficacy of Pre-hospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review. Pre-hospital and Disaster Medicine, 33, pp 299-307.

Lopez, S., Gors, T., Bernard, N., Plasse, C., Capdevila, X., (2003) Fascia Iliaca compartment block for femoral bone in pre-hospital care. Regional anaesthesia and Pain Medicine; Secaucus, 28, pp 203-207.

McRae, P, J., Bendall, J, C., Madigan, V., Middleton, P, M., (2015) Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial. The journal of Emergency Medicine, 48, pp 581-589.

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Holly Hambleton

My name's Holly Hambleton. I’m from Wolverhampton and studied Paramedic Science at Oxford Brookes University as part of the three-year BSc course. I have always been passionate about geriatric care and intrigued by pain and its management. Also, I am excited to explore new concepts that may fit into a Paramedic’s scope of practice in the future. These interests coupled together sparked my research into the exploration of the use of prehospital Fascia Iliaca Compartment Blocks for patients with femoral fractures. View more posts from Holly

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