Highlights
- •Continuous fascia iliaca block is an effective method to treat pain in adult trauma patients with hip fracture.
- •The complication rate in patients taking pre-injury anticoagulants or antiplatelet medications however is not well known.
- •We've demonstrated a low rate of infectious or bleeding complications with early use of fascia iliaca block.
- •Fascia iliaca compartment block can safely be considered in these patients.
Abstract
Background
Fascia iliaca compartment block (FICB) is an effective method to treat pain in adult
trauma patients with hip fracture. Of importance is the high prevalence of preinjury
anticoagulants and antiplatelet medications in this population. To date, we have not
identified any literature that has specifically evaluated the safety of FICB with
continuous catheter infusion in patients on antiplatelet and/or anticoagulant therapy.
The purpose of this study is to quantify the complication rate associated with FICB
in patients who are actively taking prescribed anticoagulant and/or antiplatelet medications
prior to injury and identify factors that may predispose patients to an adverse event.
Methods
This retrospective study included consecutive adult trauma patients (age ≥18) with
hip fracture who underwent placement of FICB within 24 h of admission and had been
taking anticoagulant and/or antiplatelet medications pre-injury. Patients were excluded
if their catheter was placed more than 24 h post-hospital admission. Patients were
evaluated for demographics, injury severity, laboratory values, medication history,
receipt of coagulation-related reversal medications, and complications related to
FICB placement. Complications included bleeding at the insertion site requiring catheter
removal and 30-day catheter site infection. The incidence of complications was reported
and risk factors for complications were identified using univariate and multivariate
statistics.
Results
There were 124 patients included. The mean age was 81 ± 10 years, and the most common
mechanism was ground level fall (94%). Most patients were taking single antiplatelet
therapy (65%), followed by anticoagulant alone (21%), combined antiplatelet and anticoagulant
therapy (7.3%) and dual antiplatelet therapy (7.3%). The most common antiplatelet
was aspirin (88%) and the most common anticoagulant was warfarin (60%). Of the patients
taking warfarin, the average INR on admission was 2.3 ± 0.8. Only 1 bleeding complication
(0.8%) was noted in a patient prescribed clopidogrel pre-injury which occurred 5 days
post-catheter placement. This same patient was noted to have superficial surgical
site bleeding most likely secondary to the use of enoxaparin for post-operative deep
venous thrombosis prophylaxis. There were 4 orthopedic superficial surgical site infections
(3.2%), all remote from the catheter site. The pre-injury medication prescribed in
these patients was aspirin 81 mg, aspirin 325 mg, rivaroxaban and dabigatran, respectively.
No factors were associated with a complication thus multivariate analysis was not
performed.
Conclusion
The incidence of complications associated with fascia iliaca compartment block (FICB)
in adult trauma patients prescribed pre-injury anticoagulants or antiplatelet medications
is low. In this retrospective review, we did not identify any complications that were
directly associated with the FICB procedure. Fascia iliaca block with continuous infusion
catheter placement can be safely performed on patients who are on therapeutic anticoagulant
and/or antiplatelet agents.
Graphical abstract
Graphical Abstract
Keywords
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References
- Falls and fall-related injuries among community-dwelling adults in the United States.PLoS One. 2016; 11e0150939https://doi.org/10.1371/journal.pone.0150939
- Potential opioid-related adverse drug events are associated with decreased revenue in hip replacement surgery in the older population.Geriatr Orthop Surg Rehabil. 2020; 112151459320915328https://doi.org/10.1177/2151459320915328
- Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial.Anesthesiology. 2007; 106: 773-778https://doi.org/10.1097/01.anes.0000264764.56544.d2
- The role of fascia iliaca blocks in hip fractures: a prospective case-control study and feasibility assessment of a junior-doctor-delivered service.ISRN Orthop. 2014; (2014)https://doi.org/10.1155/2014/191306
- Single fascia iliaca compartment block is safe and effective for emergency pain relief in hip-fracture patients.West J Emerg Med. 2015; 16: 1188-1193https://doi.org/10.5811/westjem.2015.10.28270
- Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture.World J. Emerg. Med. 2015; 6: 142-146https://doi.org/10.5847/wjem.j.1920-8642.2015.02.010
- Geriatric trauma G-60 falls with hip fractures: a pilot study of acute pain management using femoral nerve fascia iliac blocks.J. Trauma Acute Care Surgery. 2015; 79: 1067-1072https://doi.org/10.1097/TA.0000000000000841
- Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture.Pain Res Manag. 2015; 20: 210-212
- Fascia iliaca compartment block versus no block for pain control after lower limb surgery: a meta-analysis.J Pain Res. 2017; 10: 2833-2841https://doi.org/10.2147/JPR.S149647
- Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation.Br J Anaesth. 2018; 120: 1368-1380https://doi.org/10.1016/j.bja.2017.12.042
- The efficacy of fascia iliaca compartment block for pain control after hip fracture.Medicine (Baltimore). 2019; 98https://doi.org/10.1097/MD.0000000000016157
- The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: a meta-analysis.J Orthop Surg Res. 2019; 14https://doi.org/10.1186/s13018-018-1053-1
- A randomized controlled trial of FNB versus FICB for patients with femoral neck fractures before spinal anesthesia.Clin Interv Aging. 2020; 15: 1113-1119https://doi.org/10.2147/CIA.S251025
- Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture.Strategies Trauma Limb. Reconstr. 2008; 3: 65-70https://doi.org/10.1007/s11751-008-0037-9
- Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study.J Orthop Traumatol. 2009; 10: 127-133https://doi.org/10.1007/s10195-009-0062-6
- A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards.Pain. 2010; 150: 477-484https://doi.org/10.1016/j.pain.2010.05.028
- A continuous infusion fascia iliaca compartment block in hip fracture patients: a pilot study.J Clin Med Res. 2012; (Published online)https://doi.org/10.4021/jocmr724w
- Postoperative pain control for total knee arthroplasty: continuous femoral nerve block versus intravenous patient controlled analgesia.Anesthesiol. Pain Med. 2012; 1: 239-242https://doi.org/10.5812/aapm.3404
- Ultrasound-guided continuous fascia iliaca compartment block for pre-operative pain control in very elderly patients with hip fracture: a randomized controlled trial.Exp Ther Med. 2018; 16: 1944-1952https://doi.org/10.3892/etm.2018.6417
- Bleeding complications following peripheral regional anaesthesia in patients treated with anticoagulants or antiplatelet agents: a systematic review.Anaesth. Crit. Care Pain Med. 2019; 38: 507-516https://doi.org/10.1016/j.accpm.2018.12.009
- Outcomes of geriatric trauma patients on preinjury anticoagulation: a multicenter study.Am Surg. 2017; 83: 527-535
- The impact of antiplatelet drugs on trauma outcomes.J. Trauma Acute Care Surg. 2012; 73: 492-497https://doi.org/10.1097/ta.0b013e31825b85f1
- Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer?.J. Trauma Acute Care Surg. 2014; 76: 196-200https://doi.org/10.1097/TA.0b013e3182a833ac
- The effect of preinjury anticoagulation on mortality in trauma patients: a systematic review and meta-analysis.Injury. 2020; 51: 1705-1713https://doi.org/10.1016/j.injury.2020.06.010
- The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition.Crit Care. 2019; 23: 98https://doi.org/10.1186/s13054-019-2347-3
- Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for healthcare professionals from the Neurocritical Care Society and Society of Critical Care Medicine.Neurocritical Care. 2016; 24: 6-46https://doi.org/10.1007/s12028-015-0222-x
- Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.Reg Anesth Pain Med. 2015; 40: 182-212https://doi.org/10.1097/AAP.0000000000000223
- Regional anaesthesia in patients on antithrombotic drugs: joint ESAIC/ESRA guidelines.Eur J Anaesthesiol. 2022; 39: 100-132https://doi.org/10.1097/EJA.0000000000001600
- Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study.J Orthop Surg Res. 2019; 14: 382https://doi.org/10.1186/s13018-019-1449-6
- Surgical site infection after hip fracture surgery.Bone Joint Res. 2020; 9: 554-562https://doi.org/10.1302/2046-3758.99.BJR-2020-0023.R1
- Groupe de Recherche sur l'Antibioprophylaxie en Chirurgie. Surgical site infection after surgery to repair femoral neck fracture: a French multicenter retrospective study.Infect Control Hosp Epidemiol. 2007; 28: 1169-1174https://doi.org/10.1086/520745
- Surgical site infection following hip fracture surgery - the role of wound surveillance.J. Infect. Prevent. 2011; 12: 44-47https://doi.org/10.1177/1757177410375488
- Clinical pharmacology of platelet cyclooxygenase inhibition.Circulation. 1985; 72: 1177-1184https://doi.org/10.1161/01.cir.72.6.1177
- Combined therapy with clopidogrel and aspirin significantly increases the bleeding time through a synergistic antiplatelet action.J Vasc Surg. 2002; 35: 1204-1209https://doi.org/10.1067/mva.2002.122027
- Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation.Arch Intern Med. 2010; 170: 1433-1441https://doi.org/10.1001/archinternmed.2010.271
Article info
Publication history
Published online: September 06, 2022
Accepted:
August 24,
2022
Received in revised form:
May 20,
2022
Received:
July 5,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
