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professional
clinical skills
medications
pain management
prehospital

Allied health professional confidence in giving prehospital fascia iliaca blocks

02 January 2023
Features
02 January 2023
Volume 15 · Issue 1

Abstract

Background:

Fascia iliaca blocks (FIBs) are an efficacious form of prehospital regional anaesthesia for patients with neck of femur fracture. Current prehospital use is limited.

Aims:

The primary aim of this study was to assess procedural confidence among allied health professionals. The secondary aim was to examine concerns related to prehospital use of FIB.

Methods:

This was a qualitative study that analysed semi-structured interviews. Two recognised groups were involved: paramedics and advanced practitioners.

Results:

A total of 12 semi-structured interviews were conducted. Four factors were found to contribute to procedural confidence. All practitioners felt confident to perform the FIB. In its secondary aim, to identify concerns related to FIBs, the study found three major themes: risk of doing harm; receiving adequate training; and procedural governance.

Conclusions:

Procedural confidence was high. Training and governance were highlighted as barriers to procedural expansion. Research is required to assess feasibility.

The fascia iliaca block (FIB) is an efficacious form of regional anaesthesia indicated for use in the management of neck of femur fractures (NOFFs) (Scottish Government, 2019).

Neck of femur fractures occur in a largely geriatric population (Brennan nee Saunders et al, 2003). There is a well-recognised 1-year mortality rate of 30% after sustaining a NOFF (Kearns et al, 2013). Largely, this is a result of the multimorbid status of these patients (Brennan nee Saunders et al, 2003). Because of this, these patients are vulnerable to the side effects of opiate-based analgesia (Mangram et al, 2015). Therefore, the FIB lends itself well for use in this cohort to provide opiate-sparing analgesia (Guay et al, 2017).

Further perceived benefits include the provision of long-lasting, higher-quality analgesia for patients with perioperative NOFFs (Chesters and Atkinson, 2014; Steenberg and Møller 2018; Tarekegn and Sisay, 2021). Alongside this, multiple literature reviews have reported low to negligible complications associated with the procedure (Chesters and Atkinson, 2014; Guay et al, 2017; Steenberg and Møller, 2018; O'Reilly et al, 2019; Zhang et al, 2019). Given these findings, it is nationally recognised that this procedure should be performed in patients presenting to the emergency department (ED) with a NOFF (Scottish Government, 2019).

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Paramedic
Prehospital
Fascia iliaca block
Neck of femur fracture
Regional anaesthesia