Single shot Fascia iliaca compartment block by an orthopaedic resident analgesia following hip surgery

Abstract

Background: Trauma and surgery are among the leading causes of acute pain globally. However, acute pain is inadequately managed in approximately 50% of these patients. Fascia Iliaca Compartment Block (FICB) is an inexpensive regional anaesthesia that offers additional pain control as part of multimodal analgesia.

Objective: The study assessed the efficacy of a single shot FICB in reducing post-operative pain when administered by an orthopaedic resident.

Design: This was a two-arm single blinded Randomized Controlled Trial (RCT) among patients who had undergone hip surgery at a Kenyan tertiary hospital between July 2017 and March 2019.

Methods: Those in the intervention arm received a single shot block administered through the landmark technique while the control arm received systemic analgesia alone. Pain intensity was assessed using the numerical rating scale after hip surgery with the limb in anatomical position and flexed at 15 degrees.

Results: Thirty five participants were randomized into each arm of the trial. The mean pain scores significantly declined at two, four and six hours following hip surgery in the intervention arm. The block failure rate was six (17%). Neck of femur fracture diagnosis and posterior surgical approach were associated with FICB failure (p=0.001).

Conclusions: Pain relief following hip surgery was superior for the first 6 hours in patients who received FICB based on the landmark technique by an orthopaedic resident compared to standard of care. Failure could be attributed to surgical approach.

Recommendations: A formal education program on FICB should be introduced for orthopaedic residents in a bid to improve  postoperative pain management following hip surgery in low resource settings.

Key words: Postoperative pain, Fascia iliaca compartment block, Hip surgery, Numerical rating scale.