scholarly journals Fascia Iliaca Compartment Block for Hip Fractures: Improving Clinical Practice by Audit

Cureus ◽  
2021 ◽  
Author(s):  
Isaac C Okereke ◽  
Mohamed Abdelmonem
Keyword(s):  
Clinical Practice ◽  
Hip Fractures ◽  
Fascia Iliaca Compartment Block

scholarly journals Fascia Iliaca Compartment Block for Perioperative Pain Management of Geriatric Patients with Hip Fractures: A Systematic Review of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Hao-yang Wan ◽  
Su-yi Li ◽  
Wei Ji ◽  
Bin Yu ◽  
Nan Jiang
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Pain Relief ◽  
Hip Fractures ◽  
Pain Control ◽  
Geriatric Patients ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Perioperative Pain Management ◽  
Fascia Iliaca Compartment Block

Background. With continuous increase of the aging population, the number of geriatric patients with fragility hip fractures is rising sharply, and timely surgery remains the mainstay of treatment. However, adequate and effective pain control is the precondition of satisfactory efficacy. This systematic review aimed to summarize the use of fascia iliaca compartment block (FICB) as an analgesic strategy for perioperative pain management in geriatric patients with hip fractures. Methods. PubMed and Embase databases were searched for English published randomized controlled trials (RCTs) reporting application of FICB for pain control of the older adults with hip fractures between January 1st, 2000, and May 31st, 2020. The modified Jadad scale was used to evaluate quality of the RCTs included. Primary outcomes of the eligible RCTs were presented and discussed. Results. A total of 27 RCTs with 2478 cases were included finally. The present outcomes suggested, after admission or in the emergency department (ED), FICB can provide patients with equal or even better pain relief compared with the conventional analgesia methods, which can also reduce additional analgesic consumptions. While, before positioning for spinal anesthesia (SA), FICB is able to offer superior pain control, facilitating SA performance, after surgery FICB can effectively alleviate pain with decreased use of additional analgesics, promoting earlier mobilization and preventing complications. Conclusions. FICB is a safe, reliable, and easy-to-conduct technique, which is able to provide adequate pain relief during perioperative management of geriatric patients with hip fractures.

scholarly journals Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures – effects on cognition

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pär Wennberg ◽  
Margareta Möller ◽  
Johan Herlitz ◽  
Elisabeth Kenne Sarenmalm
Keyword(s):  
Cognitive Impairment ◽  
Hip Fractures ◽  
Controlled Trial ◽  
Intervention Group ◽  
Pain Medication ◽  
Cognitive Status ◽  
Preoperative Pain ◽  
Nerve Blocks ◽  
Double Blind ◽  
Fascia Iliaca Compartment Block

Abstract Background Impaired cognition is a major risk factor for perioperative delirium. It is essential to provide good pain control in patients with hip fractures and especially important in patients with severely impaired cognitive status, as they receive less pain medication, have poorer mobility, poorer quality of life and higher mortality than patients with intact cognition. The purpose of this study was to examine the association between preoperative pain management with nerve blocks and cognitive status in patients with hip fractures during the perioperative period. Methods One hundred and twenty-seven patients with hip fractures participating in a double-blind, randomised, controlled trial were included in this study. At hospital admission, a low-dose fascia iliaca compartment block (FICB) was administered as a supplement to regular analgesia. Cognitive status was registered on arrival at hospital before FICB and on the first postoperative day using the Short Portable Mental Status Questionnaire. Results Changes in cognitive status from arrival at hospital to the first postoperative day showed a positive, albeit not significant, trend in favour of the intervention group. The results also showed that patients with no or a moderate cognitive impairment received 50% more prehospital pain medication than patients with a severe cognitive impairment. FICB was well tolerated in patients with hip fractures. Conclusion Fascia iliaca compartment block given to patients with hip fractures did not affect cognitive status in this study. Patients with a cognitive impairment may receive inadequate pain relief after hip fracture and this discrimination needs to be addressed in further studies. Trial registration EudraCT number 2008–004303-59 date of registration: 2008-10-24.

scholarly journals Clinical Practice Guidelines on Ordering Echocardiography Before Hip Fracture Repair Perform Differently from One Another

2020 ◽  
Vol 16 (S2) ◽  
pp. 378-382
Author(s):  
Eric Swart ◽  
Chris Adair ◽  
Rachel B. Seymour ◽  
Madhav A. Karunakar
Keyword(s):  
Clinical Practice ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
European Society ◽  
Operative Management ◽  
Fracture Repair ◽  
British Society ◽  
Fragility Hip Fracture

Abstract Background Osteoporotic hip fractures typically occur in frail elderly patients with multiple comorbidities, and repair of the fracture within 48 h is recommended. Pre-operative evaluation sometimes involves transthoracic echocardiography (TTE) to screen for heart disease that would alter peri-operative management, yet TTE can delay surgery and is resource intensive. Evidence suggests that the use of clinical practice guidelines (CPGs) can improve care. It is unclear which guidelines are most useful in hip fracture patients. Questions/Purposes We sought to evaluate the performance of the five commonly used CPGs in determining which patients with acute fragility hip fracture require TTE and to identify common features among high-performing CPGs that could be incorporated into care pathways. Patients and Methods We performed a retrospective study of medical records taken from an institutional database of osteoporotic hip fracture patients to identify those who underwent pre-operative TTE. History and physical examination findings were recorded; listed indications for TTE were compared against those given in five commonly used CPGs: those from the American College of Cardiology/American Heart Association (ACC/AHA), the British Society of Echocardiography (BSE), the European Society of Cardiology and the European Society of Anaesthesiology(ESC/ESA), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the Scottish Intercollegiate Guidelines Network (SIGN). We then calculated the performance (sensitivity and specificity) of the CPGs in identifying patients with TTE results that had the potential to change peri-operative management. Results We identified 100 patients who underwent pre-operative TTE. Among those, the patients met criteria for TTE 32 to 66% of the time, depending on the CPG used. In 14% of those receiving TTE, the test revealed new information with the potential to change management. The sensitivity of the CPGs ranged from 71% (ESC/ESA and AAGBI) to 100% (ACC/AHA and SIGN). The CPGs’ specificity ranged from 37% (BSE) to 74% (ESC/ESA). The more sensitive guidelines focused on a change in clinical status in patients with known disease or clinical concern regarding new-onset disease. Conclusions In patients requiring fixation of osteoporotic hip fractures, TTE can be useful for identifying pathologies that could directly change peri-operative management. Our data suggest that established CPGs can be safely used to identify which patients should undergo pre-operative TTE with low risk of missed pathology.

scholarly journals Improving Pain Control in Elderly Hip Fractures with Fascia Iliaca Compartment Block

2019 ◽  
Vol 1 (1) ◽  
pp. 13-15
Author(s):  
Leah Herzog ◽  
◽  
J. Brett Goodloe ◽  
Kristoff Reid ◽  
Ryan Barnes ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Pain Control ◽  
Fascia Iliaca Compartment Block

scholarly journals Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

2021 ◽  
Vol 45 (3) ◽  
pp. 225-259
Author(s):  
Kyunghoon Min ◽  
Jaewon Beom ◽  
Bo Ryun Kim ◽  
Sang Yoon Lee ◽  
Goo Joo Lee ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Multidisciplinary Approach ◽  
Evaluation Method ◽  
Relevant Literature ◽  
Cochrane Library ◽  
Postoperative Phase ◽  
Postoperative Rehabilitation ◽  
Post Surgery

Objective The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

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