Comparison of the Effectiveness of Fascia Iliaca Compartment Block for Preoperative Pain Relief in Patients With Intracapsular or Extracapsular Hip Fractures.

Introduction: Hip fractures can be divided into intracapsular(ICF) and extracapsular(ECF) fractures. Preoperative pain management of hip fractures is important and complex. Fascia Iliaca Compartment Block(FICB) is proven effective in reducing pain. The effectiveness may vary depending on the location of the hip fracture, given the complex nerve innervation of the hip joint. To our knowledge, the difference in effect of pre-operative FICB across the various types of hip fractures has not yet been investigated. This study compared pre-operative pain management with FICB in ICF and ECF patients. Methods: This retrospective, single center cohort study included patients(>50 years) with ICF or ECF and preoperative FICB. Numeric Rating Scale(NRS) scores at 2 time points after FICB were compared, adjusting for baseline NRS, potential confounding by prehospital opioid use and time interval between FICB and NRS-score. Also preoperative opioids use 24 hours after FICB was compared. Results: 183 patients were included; 94 ICF and 89 ECF patients. Both groups had comparable demographics(age and gender) and baseline characteristics, except for pre-injury home opioid use, which was significantly higher in the ECF patient group. NRS score before FICB-administration was 4.610(SD1.634; ICF) and 4.870(SD1.746;ECF P = 0.302) and did not differ between groups. NRS scores decreased significantly after FICB, with no significant difference between the groups: ICF: 2.900(SD1.522) and 2.360(SD1.574) and ECF 2.920(SD1.817;P = 0.834) and 2.960(SD1.938;P = 0.093) for the first and second NRS scores after FICB respectively. There was no confounding or effect modification. Opioid use in the first 24hrs after FICB was not significantly different in both groups. Conclusion: There was no statistically significant difference in preoperative pain relief provided by FICB in patients with intracapsular or extracapsular hip fractures. The FICB had great value as a regional pain block at the emergency department for both types of frail hip fracture patients.