Fascia iliaca block for pain relief from proximal femoral fracture in the emergency department: a review of the literature.

ABSTRACT

OBJECTIVES: to determine the efficacy of the fascia iliaca block in providing analgesia to patients with a proximal femoral fracture in the emergency department. METHODS: EMBASE, PubMed, CINAHL and Google Scholar were searched. Free text keywords for population, intervention and outcome were identified to create a search string. The reference lists from articles identified in the primary electronic search were hand searched. Potentially eligible studies were identified based on review of the title and abstract. If eligibility was unclear from the title and abstract, the full text was examined. Randomised controlled trials comparing the fascia iliaca block with standard analgesia were included. A standardised appraisal of the methodological quality of the studies was performed. RESULTS: 39 articles were identified, of which 13 were duplicates. Of the remaining 26, 15 were relevant to the question and suitable for further sorting. There was one conference poster presenting data, which were later published as an audit, and so was considered to be a duplicate. Of the 14 remaining papers, 2 were randomised controlled trials, 6 were cohort studies and 3 were reports of audit of practice. There were 3 abstracts of conference poster or paper submissions, which were descriptions of reviews or service development projects rather than primary studies. The two randomised controlled trials showed statistically significant superior or equal pain relief between the fascia iliaca block and other forms of acute pain relief. CONCLUSIONS: the fascia iliaca block could have an important role in first-line pain control for patients presenting to the emergency department with a proximal femoral fracture. There is potential to reform the acute management of this common group of patients.