Background and Aims FICB is recommended for NOF fracture in the AED to improve analgesia1 and as an adjuvant to anaesthesia during surgery2. Surgical repair of the fracture should be performed on the day of, or the day after, admission3. We evaluated the provision of FICB in AED and its potential to cause local anaesthetic (LA) toxicity when followed by a further block at time of surgery.
Methods All patients admitted to our institution with NOF fracture during October 2019 were retrospectively screened for FICBs. We recorded the time of: admission, FICB in AED, surgery, FICB in theatre and LA dose. Data was cross-referenced and validated against National Hip Fracture Database (NHFD) tables. Toxicity thresholds were taken from the British National Formulary and medicines.org.uk websites. Ethical approval was granted.
Results 36 patients were identified. 14(39%) received a FICB in AED, 6(16%) a peripheral nerve block in theatre and 3(8%) received both. On average, each block delivered 100 mg of L-bupivocaine. Table-1 details times from admission to surgery and from block in AED to surgery. The maximum recommended doses of L-bupivocaine in 24 hours and post-operative analgesia are respectively 400 mg and 18.75 mg/h.
Conclusions Pain promotes delirium2 and worsens outcomes hence effective pain relief between admission and surgery is key to NOF fracture treatment. Our data matched the NHFD tables and highlighted the potential for LA toxicity in patients receiving a FICB in AED and same-day-of-admission surgery.
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