Ultrasound‑guided fascia iliaca compartment block for pain control in peritrochanteric fractures in the emergency department: A prospective observational study
S. R. Vinayak1
, Sibin Surendran2, R. S. Krishnakumar3, S. L. Akhil4, Austin Joju Mangaly5, Midhun Mohan6, Chandni Radhakrishnan7
1Department of Critical Care Medicine, Aster Medcity, Kochi, Kerala, India
2Department of Orthopedics, Government Medical College, Kozhikode, Kerala, India
3Department of Emergency Medicine, Kerala Medical College, Palakkad, Kerala, India
4Department of Emergency Medicine, Government Medical College, Thrissur, Kerala, India
5Department of Emergency Medicine, Northampton General Hospital NHS Trust, Northampton, UK
6Department of Emergency Medicine, Kozhikode District Cooperative Hospital, Kozhikode, Kerala, India
7Department of Emergency Medicine, Government Medical College, Kozhikode, Kerala, India
Keywords: Analgesia, emergency service, fascia iliaca compartment block, hip fractures, hospital, interventional, pain management, ultrasonography, Visual Analog Scale
Abstract
OBJECTIVE: Hip fractures are associated with moderate to severe pain, which is frequently managed inadequately in emergency departments (EDs). This study set out to evaluate the analgesic effectiveness of an ultrasound guided fascia iliaca compartment block (FIB) administered by emergency physicians to patients with peritrochanteric hip fractures.
METHODS: A prospective observational study was conducted on 142 patients presenting to the ED with peritrochanteric hip fractures and a baseline Visual Analog Scale (VAS) score of 4 or higher. An ultrasound guided FIB was performed, and pain scores were assessed at baseline, 1, 2, and 6 h. The primary outcome was ≥ 50% reduction in VAS. The secondary outcomes included need for rescue analgesia (intravenous fentanyl 1 µg/kg) and adverse events. Data were nonnormally distributed and analyzed using the Friedman test with Bonferroni adjusted pairwise comparisons. Effect size and 95% confidence intervals (CIs) were calculated.
RESULTS: The median VAS decreased from 7 (interquartile range [IQR]: 6–8) at baseline to 3 (IQR: 2–3) at 1 h, 2 (IQR: 1–2) at 2 h, and 1 (IQR: 1–2) at 6 h (P < 0.001, Friedman test; effect size r = 0.83). A successful block (≥50% VAS reduction) was achieved in 97.2% of patients (95% CI: 92.9%–99.1%). Only 4 (2.8%) patients required rescue fentanyl. No complications, including local anesthetic systemic toxicity or delirium, were recorded.
CONCLUSION: Ultrasound guided FIB administered by trained emergency physicians is associated with significant and sustained analgesia in patients with peritrochanteric hip fractures, with minimal need for rescue opioids and no observed adverse events.
How to cite this article: Vinayak SR, Surendran S, Krishnakumar RS, Akhil SL, Mangaly AJ, Mohan M, et al. Ultrasound‑guided fascia iliaca compartment block for pain control in peritrochanteric fractures in the emergency department: A prospective observational study. Turk J Emerg Med 2026;26:217-22.