Pain management is an integral part of providing care in the emergency setting. Lower extremity pain from hip fractures, burns, and other trauma is a common presenting complaint. Unfortunately, pain management can be difficult due to medication side effects, patient preferences, and other patient characteristics that can make intravenous analgesia less desirable. Opioid medications can be associated with respiratory depression, hypotension, mental status changes, and vomiting. NSAIDs can increase bleeding risk and exacerbate underlying gastrointestinal (GI) problems. Acetaminophen alone is often not sufficient for severe pain. Hip fractures, in particular, can cause considerable pain, and often occur in elderly adults with multiple comorbidities which make analgesia challenging.
A fascia iliaca compartment block can provide superior analgesia with minimal side effects. It can be deployed in a relatively quick fashion after a small amount of training and can be executed with high success rates under ultrasound guidance. In a study by Monzon et al., patients who received a fascia iliaca compartment block for a hip fracture had significantly reduced pain levels. The pain was initially rated at an average of 8.5 on a 10 point scale but decreased to an average of 2.3 at 2 hours post-injection. In a study by Stevens et al., in Anesthesia Intensive Care, patients who underwent a fascia iliaca compartment block used significantly less morphine over the course of 24 hours than the control group which used morphine alone. An additional advantage is the duration of effect, which has been seen for 8 to 10 hours following a single shot block. Another randomized placebo-controlled trial showed that pain relief was superior at all time points measured in the fascia iliac compartment block group as compared with a group utilizing morphine only. In fact, median total morphine consumption in the compartment block group was 0 mg due to excellent analgesia after only a compartment block. Similar results were seen in a study by Lopez et al. for femoral shaft fractures. Emergency department-specific studies using ultrasound guidance have shown 76% mean reduction of pain score in patients with hip fracture at 120 minutes.