Ultrasound-guided Fascia Iliaca Block (FIB) in the emergency department: Efficiency and safety

##plugins.themes.academic_pro.article.sidebar##

Published May 1, 2025
https://doi.org/10.62438/tunismed.v103i5.5535
Download
pdf
Vol. 103 No. 5 (2025): Tunis Med May 2025

##plugins.themes.academic_pro.article.main##

Aymen Zoubli
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia
Abdelaziz Ben Taher
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia
Nizar Fitouhi
Department of Anaesthesia and Intensive Care, Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunisia
Ahmed Amin Abri
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia
Hana Hedhli
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia
Assma Jendoubi
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia
Safia Othmani
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia
Dhekra Hosni
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia
Sarra Jouini
Emergency Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunisia

Abstract

Introduction: Hip and femoral shaft fractures are extremely painful injuries, usually occurring in
elderly, multi-talented patients who are vulnerable to opioids. In this context
ultrasound-guided locoregional analgesia (LRA) could be an interesting alternative.
Aim : To study pain variation (Delta numerical scale) in hip and
thigh trauma patients treated with ultrasound-guided Fascia Iliaca block (FIB) in the emergency department.
Methods: We conducted an observational study over a period of 10 months, including all patients aged 16 and over, who consulted us for isolated hip or thigh trauma, in whom the numeric rating scale (NRS) could be assessed. The primary endpoint was a significant reduction in pain (ΔNRS ≥2). Secondary endpoints were local or general complications and the use of rescue analgesia.
Results: Forty-two patients were included. Mean age was 66±17 years, with a sex ratio of
0.9. The mean initial NRS was 9.12±1.3. Mean NRS value was 5.6 at 30 minutes and 3.9 at 120 minutes. Eighty-five percent of patients had a significant reduction in pain after 30 minutes of IFB, and six patients required rescue analgesia with morphine. No adverse effects were recorded.
Conclusion: Ultrasound-guided FIB can be safely performed by emergency physicians in an emergency department, after appropriate training in the technique

Keywords:

Pain, Nerve block, Ultrasound, Trauma, Hip fracture, Emergency

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. (1) Aubrun F. Fracture de l’extrémité supérieure du fémur du patient âgé: aspect épidémiologique, facteurs de risque. Ann Fr Anesth Reanim. Oct 2011;30(10):37-9.
  2. (2) Société française d'anesthésie et de réanimation. Pratique des anesthésies locales et locorégionales par des médecins non spécialisés en anesthésie réanimation, dans le cadre des urgences. Ann Fr Anesth Reanim. Mar 2004;23(2):167-76.
  3. (3) Gaertner E, Pavlakovic I, Rideau C, Eisenberg E, Tubert V, Maschino X. Place de l’échographie dans l’anesthésie et l’analgésie locorégionale. Douleur. evaluat. diag. trait. [En ligne]. Février 2008 [Consulté le 5 avril 2024]; 9(1):[ 6 pages].
  4. Consultable à l’URL: https://www.sciencedirect.com/science/article/abs/pii/S1624568708000048
  5. (4) Morrison RS, Magaziner J, Gilbert M, Koval KJ, McLaughlin MA, Orosz G, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. Gerontol A Biol Sci Med Sci. 2003 Jan;58(1):76-81.
  6. (5) Casey S, Stevenson D, Mumma B, Slee C, Wolinsky P, Hirsch C, et al. Emergency department pain management following implementation of a geriatric hip fracture program. West J Emerg Med. 2017 Jun;18(4):585-91.
  7. (6) Laffosse JM, Molinier F, Puget J. Fracture de l’extrémité supérieure du fémur chez l’adulte. Rev Prat. Mar 2008;58(6):649-57.
  8. (7) Prulière AS, Finance JF, Lafforgue P, Guillotin P, Laurent JP, Chansou A, et al. Faisabilité des échelles d’auto évaluation de la douleur aux urgences. J. eur. urg. [En ligne]. Juin 2005 [Consulté le 5 avril 2024]; 18(6):[ 7 pages]. Consultable à l’URL: https://www.em-consulte.com/article/110411/faisabilite-des-echelles-d-auto-evaluation-de-la-d
  9. (8) Tomta K, Mouzou T, Egbohou P, Chobli M. Echelle visuelle analogique versus échelle numérique dans l’évaluation de la douleur chez l’adulte en salle de surveillance post interventionnelle, au (CHU) Tokoin de Lomé (Togo). J. rech. sci. univ. lomé. [En ligne]. Février 2009 [Consulté le 5 avril 2024]; 11(2):[ 8 pages]. Consultable à l’URL: https://www.ajol.info/index.php/jrsul/article/view/57032
  10. (9) Delaunay L, Plantet F, Jochum D. Échographie et anesthésie locorégionale. Ann Fr Anesth Reanim. Fév 2009;28(2):140-60.
  11. (10) Simon P, Gouin F, Veillard D, Laffargue P, Ehlinger M, Bel JC, et al. Les fractures du col du fémur après 50 ans. Rev Chir Orthop Reparatrice Appar Mot. Oct 2008;94(6):108-32.
  12. (11) Liu SS, Ngeow JE, Ya Deau JT. Ultrasound guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med. 2009 Jan;34(1):47-59.
  13. (12) Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010 Jan;28(1):76-81.
  14. (13) McRae PJ, Bendall JC, Madigan V, Middleton PM. Paramedic performed fascia iliaca compartment block for femoral fractures: a controlled trial. J Emerg Med. 2015 May;48(5):581-9.
  15. (14) Dochez E, Van Geffen GJ, Bruhn J, Hoogerwerf N, Van De Pas H, Scheffer G. Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study. Scand J Trauma Resusc Emerg Med. 2014 Jun;22:38.
  16. (15) Gros T, Viel E, Ripart J, Delire V, Eledjam JJ, Sebbane M. Bloc fémoral en analgésie préhospitalière pour traumatisme du membre inférieur, enquête de pratique observationnelle sur 107 cas. Ann Fr Anesth Reanim. Nov 2012;31(11):846-9.
  17. (16) Gozlan C, Minville V, Asehnoune K, Raynal P, Zetlaoui P, Benhamou D. Fascia iliaca block for femoral bone fractures in prehospital medicine. Ann Fr Anesth Reanim. Juin 2005;24(6):617-20.
  18. (17) Lopez S, Gros T, Bernard N, Plasse C, Capdevila M. Fascia iliaca compartment block for femoral bone fractures in prehospital care. Reg Anesth Pain Med. 2003 May;28(3):203-7.