Fascia Iliaca Blocks in Elderly with Hip Fractures: A Critical Evaluation

The purpose of this study was to determine the effectiveness of the fascia iliaca block (FIB) in on our geriatric hip fracture population and determine its effect on outcome. The study included hip fracture patients 65 and older in a therapeutic case control in an urban, orthopaedic hospital with attending anesthesiologist choice in administering the FIB in the preoperative holding area. Pain scores, narcotic pain usage, physical therapy parameters and discharge disposition were measured. One hundred and nine patients that did not receive the FIB served as the control group, while 80 patients received the FIB. The average patient age was 79 (62 - 100) for the control group and 82 (62 - 102) for the FIB. Postoperatively, the FIB group reported their highest pain score at an average of 30 hours compared to the non-FIB group at 17 hours after surgery (p < 0.006). In the control group, 49 (45%) were discharged home, and 40 (37%) discharged to a skilled nursing facility (SNF) and 20 discharging to a rehab facility. In comparison, only 19 (24%) FIB patients were discharging home, and 61 (55.6%) went to SNF (p < 0.005). The FIB significantly increased the time until the high pain score without decreasing pain for the expected duration of the block. A concern with the FIB use is possible delays in physical therapy due to the duration of the block. Objective physical therapy parameters were more robust for the control on postoperative day 0 and day 1 in regard to ambulation. Level of Evidence: Level III. (Journal of Surgical Orthopaedic Advances 35(2):059-062, 2026).