Background and aims Fascia iliaca (FI) or femoral nerve blocks provide dynamic analgesia in patients with hip fractures and reduce opioid requirements. the National Hip Fracture Database (NFHD) showed our hospital pre-operative block rate was approximately 8% compared to 50% nationally. Our aim is therefore to improve regional analgesia delivery to our patients.
Methods The emergency department (ED) was identified as a suitable location for patients to receive FI blocks, providing early analgesia. Identifying a permanent staff group to perform this procedure is vital to ensuring sustainability, which in our ED are advanced care practitioners (ACPs). They have received training and a guideline has been developed.
For ward patients we have developed a ‘Block Grab Bag’ containing essential equipment for anaesthetists to place blocks. Specialist trauma nurses track patients and request blocks electronically.
Results We have collected data on 30 anaesthetist delivered femoral nerve blocks, reviewing opioid consumption, static and dynamic pain scores pre- and post-block. the NHFD run chart shows an increase in monthly block rate; with the latest at 20%. Static and dynamic pain scores demonstrate efficacy (figures 1 and 2). the mean (SD) opioid consumption for each patient pre-block was 10.1 (11.3) mg compared to 1.8 (3.1) mg post-block until time of surgery.
Conclusions We have implemented a preoperative block pathway for hip fracture patients and demonstrated efficacy in a sample group. Supporting ACPs with block performance will reduce demand on anaesthetic services. We plan further expansion in the service with nurse delivered FI blocks.
Local Caldicott Guardian approval received for publication of data.
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