Preoperative Fascia Iliaca Blocks Associated with Decreased Opioid Consumption in Femoral Shaft and Distal Femur Fractures

Abstract

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, and readmission rate. Methods: 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, length of stay, discharge disposition, and 30-day readmission rate were compared between patients undergoing fascia iliaca compartment block and not receiving the block. Results: 136 patients were included. Twenty-four received fascia iliaca block. Both cohorts were primarily female gender 66.7% and 66.9%, respectively for the FI block and no FI block cohort. The majority of the FI block cohort (62.5%) had femoral shaft fractures, while the no FI block cohort had mostly distal femur fractures (56.2%). 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 pre-operatively (36.1 vs 55.3 morphine milliequivalents (MMEs), p=0.030), post-operatively (71.7 vs 130.6 MMEs, p=0.041), over total hospital stay (107.9 vs 185.9 MMEs), and mean opioid consumption per day of hospital stay (25.9 vs 48.4 MMEs, p=0.003). There was no significant difference in length of stay (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 fascia iliaca 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 length of stay, discharge disposition, or 30-day readmissions. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.