References
Fascia iliaca compartment block versus IV morphine for femoral fracture pain
Abstract
Background:
Femoral trauma in the UK is increasing. The fascia iliaca compartment block (FICB) could be a more effective, safer way to ease pain and distress from femoral trauma in the prehospital environment than the current practice of intravenous morphine.
Aim:
To conduct a systematic review to accumulate evidence concerning prehospital FICB for patients with femoral fracture.
Methodology:
A systematic review was conducted using the CINAHL, Medline, AMED, PubMed and Embase databases. In addition, a hand search of the Journal of Paramedic Practice and the Australasian Journal of Paramedicine was performed. The search was carried out from 28 March–24 April 2018.
Results:
Twenty-eight papers were sourced by the methodology, of which four met the inclusion criteria and were subsequently analysed.
Conclusion:
This review shows that prehospital FICB can be efficacious in a number of prehospital environments and is feasible for a variety of patients with a range of femoral fractures. Additionally, FICB has limited reported adverse side effects in the prehospital environment and would appear to be safe. However, evidence comparing the efficacy of a prehospital FICB to intravenous morphine use for pain management in femoral fractures is limited. This review indicates that more research in this area would be beneficial.
Femoral fractures affect a range of patients from young adults (Khan et al, 2017) to the elderly (Fujihara et al, 2013). They are occurring more frequently in the UK (Court-Brown et al, 2014). The Royal College of Physicians (2015) reported the annual incidence of the most common femoral fracture, proximal femoral fracture (PFF) as 76 000 in 2010; this is projected to increase to more than 100 000 by 2020. Adequate prehospital analgesia for all of these patients is vital (Sprague et al, 2018).
Currently, the gold standard for prehospital analgesia is morphine and other opiate derivatives delivered intravenously (Small and Aldington, 2014). Morphine is effective (Fleischman et al, 2010) but can cause nausea, vomiting, delirium, respiratory depression and sedation (Chau et al, 2008). Therefore, it is used cautiously and avoided by clinicians when these potential side effects may worsen a patient's condition (Vassiliadis et al, 2002; Del Vecchio et al, 2017). Some patients are left in pain until an alternative analgesic medication can be administered (Simpson et al, 2013). Could an alternative prehospital technique improve the pain management of femoral fractures?
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