BBC HIP FRACTURE:
CONTINUOUS FASCIA
ILIACA BLOCKS
Monday, August 27,
2018
Steven Lins, M.D.
ASPIRE Quality Champion
Bronson Battle Creek
• Scope of problem
– >300,00 hip fractures in US/year
– Rate is declining but incidence is increasing
due to aging population
– Approximately 30% one year mortality rates
– 1-10% mortality during hospital stay
– 50% lose ability to care for themselves
BBC Hip Fractures, FI Block
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• BBC Anesthesiology Initiatives
– 2015 tried femoral nerve blocks on arrival to OR along with multimodal
analgesics post-op.
• This improved post-op pain relief and narcotic consumption
– 2017 changed to single shot fascia iliaca blocks upon surgery arrival
• Better blockade of Obturator and Lateral Femoral Cutaneous
Nerves with less effect on Quadriceps muscle strength
– Jan, 2018 Began continuous fascia iliaca blocks on arrival to
surgery and continued for up to three days post-op. Further
reduced opioid consumption and post-op delirium (anecdotal –
Have not gathered data)
- Patients continued to receive high doses of narcotics between
ED and surgery with frequent delirium on arrival to surgery.
Many could not sign their own consent.
BBC Hip Fractures FI Block
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• Began Continuous FI Block on arrival to ED on
April 9, 2018
– ED physician notifies anesthesia of patient. Narcotics are
avoided
– Anesthesia obtains consent and places continuous block
catheter at fascia iliaca and boluses with dilute local
anesthetic (0.2% ropivicaine)
– Anesthesia places order for multimodal analgesics and
continuous nerve block infusion (0.2% Naropin at 6
mL/hour.
– Floor nurse connects continuous infusion to block
catheter
BBC Hip Fractures FI Block
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• Results
– Demographics
– 20 patients prior to program start (12/25/17 –
4/9/18)
– 20 patients with block placed in ED (4/9 - )
BBC Hip Fractures: FI Blocks
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#
Male
Female
Avg
Age
Time to
Surgery
W/O
Block
20 7 13
79.01
22.8
hours
With
BLOCK
20 3 17
81.85
27.6
hours
• Results
BBC Hip Fracture: FI Block
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Pain score
First 8
hours
Pain score
Second 8
hours
Pain score
Third 8
hours
Without
block
7.97 6.17 7.03
With block
4.89 3.7 2.92
• Results:
BBC Hip Fracture: FI Block
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IV
MS EQ
First 8
hours
IV MS EQ
Second 8
hours
IV MS EQ
Third 8
hours
LOS
LOS
After
Surgery
Without
Block
10.2 5.6 4.55 5 4.05
With
Block
3.56 2.1 0.98 4.7 3.55
• What we see (Anesthesia rounds every
day on every patient)
– Less delirium pre-op and less delirium post-op
– More mobility – Fracture order set has been
modified to have patient sit out of bed for all
meals and 1 hour after, up w/assistance
– Greater patient AND family satisfaction
– Greater RN satisfaction
BBC Hip Fracture : FI Blocks
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• To Be Determined
– CAM Scores
– Effect on placement/independent living
– Mortality Rates: In hospital and 1 year
– LOS compared to benchmark
– HCAHP Scores
BBC Fractured Hip: FI Blocks
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Thank you!
bronsonhealth.com
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