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Published on: September 16, 2022
Preoperative Fascia Iliaca Blocks Associated With Decreased Opioid Consumption in Femoral Shaft and Distal Femur
Nicholas Kolodychuk1, Michael Dubé2,3, Nicholas DiNicola3
1Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY.
Objectives:
To examine the impact of fascia iliaca (FI) blocks performed in the emergency department on femoral shaft and distal femur fracture patients on opioid consumption, length of stay (LOS), and readmission rate.
Design:
Prospective cohort study.
Setting:
Community-based Level 1 trauma center.
Patient Selection Criteria:
Patients with isolated low-energy femoral shaft or distal femur fractures (OTA/AO 32 and 33) presenting from January 1, 2020, to May 31, 2022, were included.
Outcome Measures And Comparisons:
Opioid consumption, LOS, discharge disposition, and 30-day readmission rate were compared between patients undergoing FI compartment block and not receiving the block.
Results:
One hundred thirty-six patients were included. Twenty-four received FI block. Both cohorts were primarily female gender (66.7% and 66.9%, respectively, for the FI block and the no FI block cohort). Most of the FI block cohort had femoral shaft fractures (62.5%), whereas the no FI block cohort had mostly distal femur fractures (56.2%). The mean body mass index, fracture type, and surgical procedure were similar between patients undergoing FI block and not receiving FI block. The FI block group had significantly lower opioid consumption preoperatively [36.1 vs. 55.3 morphine milliequivalents (MMEs), P = 0.030], postoperatively (71.7 vs. 130.6 MMEs, P = 0.041), and over total hospital stay (107.9 vs. 185.9 MMEs) including the mean opioid consumption per day of hospital stay (25.9 vs. 48.4 MMEs, P = 0.003). There was no significant difference in LOS (4.9 vs. 5.0 days, P = 0.900), discharge disposition destination ( P = 0.200), or 30-day readmissions (12.5% vs. 4.5%, P = 0.148) between groups.
Conclusions:
Undergoing FI block in the emergency department was associated with decreased opioid consumption in patients with femoral shaft or distal femur fractures. There was no associated difference in LOS, discharge disposition, or 30-day readmissions.
Level Of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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