Academic Journal
Challenging the Paradigm: Fascia Iliaca Blocks May Not be Necessary for All Neck of Femur Fractures.
| Title: | Challenging the Paradigm: Fascia Iliaca Blocks May Not be Necessary for All Neck of Femur Fractures. |
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| Authors: | Boylan CT; Aintree University Hospitals NHS Foundation Trust, Trauma and Orthopaedic Surgery, Liverpool, United Kingdom. Electronic address: conortboylan@gmail.com., Yousuf ZA; Aintree University Hospitals NHS Foundation Trust, Trauma and Orthopaedic Surgery, Liverpool, United Kingdom., Samarakoon G; Aintree University Hospitals NHS Foundation Trust, Trauma and Orthopaedic Surgery, Liverpool, United Kingdom., Bulut H; Istanbul University Cerrahpasa, Medical School, Istanbul, Turkey., Lam C; University of Birmingham, Medical School, Birmingham, United Kingdom., Moss M; Royal Bolton NHS Foundation Trust, Trauma and Orthopaedic Surgery, Bolton, United Kingdom., Verstraten L; Aintree University Hospitals NHS Foundation Trust, Trauma and Orthopaedic Surgery, Liverpool, United Kingdom. |
| Source: | The Journal of emergency medicine [J Emerg Med] 2026 Aug; Vol. 87, pp. 90-99. Date of Electronic Publication: 2026 May 06. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 8412174 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0736-4679 (Print) Linking ISSN: 07364679 NLM ISO Abbreviation: J Emerg Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2010>- : New York : Elsevier Original Publication: New York : Pergamon Press, c1983- |
| MeSH Terms: | Nerve Block*/methods , Nerve Block*/standards , Femoral Neck Fractures*/complications , Pain Management*/methods , Pain Management*/standards, Pain Measurement/methods ; Analgesics, Opioid/therapeutic use ; Humans ; Female ; Retrospective Studies ; Case-Control Studies ; Male ; Aged, 80 and over ; Aged ; Fascia ; Proximal Femoral Fractures ; United Kingdom |
| Abstract: | Background: Fascia iliaca blocks (FIB) are recommended by national guidelines for analgesia in neck of femur (NOF) fractures to reduce opioid burden. However, evidence supporting universal administration is largely derived from patients with moderate-to-severe pain. It remains unclear whether ``blanket'' FIB protocols benefit the heterogeneous population presenting to emergency departments. Objectives: To evaluate real-world analgesic efficacy of FIBs across baseline pain severities and to assess whether a targeted approach is justified. Methods: Single-centre, retrospective case-control study of adults presenting to a UK Major Trauma Centre with radiologically confirmed NOF fractures. Changes in pain scores and opioid consumption (Morphine Milligram Equivalents [MME]) were analyzed pre- and post-intervention. Outcomes were compared between FIB and standard analgesia, and between ultrasound-guided and landmark techniques. Results: Of 112 included patients (80.2 ± 9.4 years; 74.1% female), 87 (77.7%) received a FIB. While FIB resulted in a statistically significant reduction in pain scores (4.7 ± 3.8 to 2.0 ± 2.8; p = 0.003), it did not significantly alter opioid consumption (median 0.00 vs 0.47 MME/h; p = 0.961). Subgroup analysis revealed that analgesic benefit was strongly correlated with baseline pain (r = 0.771, p < 0.001); patients with rest pain <4 derived minimal benefit. No significant difference in efficacy was observed between ultrasound-guided and landmark techniques. Conclusion: Universal FIBs for NOF fractures may represent an inefficient use of resources for patients with low baseline pain. A stratified protocol prioritising patients with moderate-to-severe pain (Visual Analogue Scale [VAS]/Numerical Rating Scale [NSR] ≥ 4) is recommended. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Acute pain management; Emergency department; Fascia iliaca block; Hip fracture; Neck of femur fracture; Opioid consumption; Regional anaesthesia; Targeted analgesia |
| Substance Nomenclature: | 0 (Analgesics, Opioid) |
| Entry Date(s): | Date Created: 20260611 Date Completed: 20260714 Latest Revision: 20260714 |
| Update Code: | 20260714 |
| DOI: | 10.1016/j.jemermed.2026.04.025 |
| PMID: | 42275900 |
| Database: | MEDLINE |
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