Reducing post-traumatic morbidity with pain management

Systematic review and meta-analysis of single injection fascia iliaca blocks in the peri-operative management of patients with hip fractures

INTRODUCTION

The aim of the study was to determine the analgesic efficacy and safety profile of single injection fascia iliaca compartment block (FICB) performed peri-operatively for isolated hip fractures.

EVIDENCE ACQUISITION

MEDLINE, EMBASE, Cochrane and CINAHL were searched from inception to February 2018. Inclusion criteria were: English language, adult patients (>18 years old), isolated traumatic hip fracture treated with single injection FICB peri-operatively. Data were extracted into a pre-piloted form that utilized the PRISMA-P 2015 checklist. Two investigators conducted reviews independently; any ambiguity was resolved by discussion. The quality of studies was assessed using the GRADE checklist and Cochrane risk of bias tool. A random-effects model was applied. Outcomes reviewed were pain level at rest and movement, breakthrough analgesia and complications.

EVIDENCE SYNTHESIS

Out of 3757 citations, eight RCTs were included involving 645 participants. Pain was significantly reduced during movements (SMD=-1.82, 95% CI -2.26 to -1.38, P<0.00001) but not at rest (SMD=-0.68, 95% CI -1.70 to 0.35, P=0.20). FICB allowed less (breakthrough) supplemental analgesic (N.=57 vs. N.=73), however this did not reach statistical significance (P=0.19).

CONCLUSIONS

FICB is effective in controlling acute peri-operative pain in adult patients with traumatic hip fractures. The benefit is more evident during mobilization of the limb when compared to patients at rest.

Regional anesthesia in trauma patients

Medical and surgical treatment of the trauma patient has evolved in the last decade. Treatment of pain from multiple fractures or injured organs and surgical anesthesia with regional anesthesia techniques have been used to reduce post-traumatic stress disorder and reduce the adverse effects of general anesthesia. Neuraxial blocks and peripheral nerve block techniques should be practiced by trained emergency and operatory room staff. This article reviews recent publications related to the role of regional anesthesia in trauma patients in the prehospital, emergency, and operatory room settings. It also describes indications, limitations, and practical aspects of regional anesthesia.