Prehospital administered fascia iliaca compartment block by emergency medical service nurses,
a feasibility study
Sammanfattning
INTRODUCTION:
Patients with a proximal femur fracture are often difficult to evacuate from the accident scene.
Prehospital pain management for this vulnerable group of patients may be challenging. Multiple co-
morbidities, polypharmacy and increased age may limit the choice of suitable analgesics. The fascia
iliaca compartment (FIC) block may be an alternative to intravenous analgesics. However this
peripheral nerve block is mainly applied by physicians.In the Netherlands, prehospital emergency
care is mostly provided by EMS-nurses. Therefore we examined whether well-trained EMS-nurses
are able to successfully perform a FIC block in order to ensure timely and appropriate effective
analgesia.The study was study was registered in the Netherlands Trial Register (NTR-nr 3824).
METHODS:
Ten EMS nurses were educated in the performance of a FIC-block. Indications, technique, side-effects
and complications were discussed. Hereafter the trained EMS-nurses staffed ambulance teams were
dispatched to patients with a suspicion for a proximal femur fracture. After confirmation of the
diagnosis, the block was performed and 0.3 ml/kg lidocaine (10 mg/ml) with adrenaline 5 ?g/ml was
injected. The quality of pain relief, occurrence of complications and patient satisfaction were
evaluated.
RESULTS:
In 108 patients a block was performed. One hundred patients could be included. Every EMS nurse
performed at least 10 FIC blocks. The block was effective in 96 patients. The initial median (NRS)-pain
score decreased after block performance to a score of 6 (after 10 minutes), 4 (after 20 minutes) and 3
(after 30 minutes). At arrival at the Emergency Department the median pain score was 3. Dynamic
NRS-pain scores when transferring the patient from the accident scene to the ambulance stretcher,
during transportation to the hospital and when transferring the patient to a hospital bed were, 4, 3 and
3.5 respectively. Patient satisfaction was very high. No complications were noted.
CONCLUSION:
Additional educated EMS-nurses are able to successfully perform a FIC-block for providing acute pain
relief to patients with a suspected proximal femur fracture.