149 Reducing Complications and Improving Outcomes Following Total Hip Arthroplasty

Aim Neck of femur (NOF) fractures are increasing, and the need to improve mobility and reduce complications whilst improving discharge time is an ongoing challenge. Hip fracture fixation and arthroplasty are essential in improving pain and mobility. NOF patients often undergo a fascia iliaca block (FIB) to improve outcomes. Guay J’s Cochrane systematic review confirms that FIBs reduce pain pre and postoperatively, decrease hospital-acquired pneumonia risk and improve mobility. Patients on anticoagulants are typically refused bedside blocks, however we are unsure if they truly impact adverse outcomes in FIBs for NOF patients. Method A retrospective observational study was undertaken to assess complication rates in 53 NOF patients who had a FIB at St Mary’s Hospital between 07/01/2020 and 26/06/2020. Patients whose NOF was the result of an inpatient fall were excluded. Pre-existing anticoagulant and antiplatelet use were noted, as were the A&E admission blood coagulation results. Local complications which may have arisen post-FIB were closely screened for in documentation until the patient’s discharge date. Results There were no local complications in all 53 patients. Interestingly, one patient had a documented thigh haematoma pre-nerve block, but did not have any evolution of the haematoma and achieved good pain relief from the block. Conclusions FIBs appear to be a safe and effective analgesic tool in the perioperative NOF patient and use has been reported to reduce early complications in those who undergo hip fracture treatment. We aim to implement these findings and increase the rate of nerve block procedures in NOF fractures.

Efficacy of Ultrasound Guided Fascia Iliaca Block for Pain Management Compared to Conventional Pain Killers; A Comparative Study

Objective: The aim of this study is to determine the efficacy of ultrasound guided fascia iliaca block for pain management compared to conventional pain killers. Study Design: Place and Duration: The study was conducted at the emergency department of Lady Reading Hospital Peshawar for duration of six months i.e June 2019 to December 2019. Methods: Total 80 patients of both genders underwent for arthroplasty were presented in this study. Patients were aged between 40-80 years. Patients detailed demographics age, sex, weight and body mass index were recorded after taking informed written consent. Patients were divided into 2-groups. Group I had 40 patients and received fascia iliaca block while group II received conventional pain killers with 40 patients. Postoperative outcomes reduction in pain score was assessed by visual analog scale (VAS). Postoperatively complications and patients satisfaction was also observed and compared among both groups. Complete data was analyzed by SPSS 26.0version. Results: There were 22 (55%) male and 18 (45%) female patients in group I while in group II male patients were 21 (52.5%) and 19 (47.5%) were females. Mean age in group I was 57.17±10.21 years with mean BMI 26.64±3.54 kg/m2 and in group II mean age was 58.25±9.66 years with mean BMI 26.48±3.45 kg/m2. 25 (62.5%) patients had ASA I and 15 (37.5%) had II in group I but in group II 24 (60%) had ASA I and 16 (40%) had II. Post-operative after 48hrs pain score in group I was 2.03±3.18 lower as compared to group II 4.08±7.81. Frequency of complications was higher in group II 23 (57.5%) as compared to group I 8 (20%). Satisfaction among patients of group I was 34 (85%) higher as compared to group II 19 (47.5%). Conclusion: We concluded in this study that the use of anesthesia fascia iliaca block was effective in terms of pain reduction and fewer complications than conventional pain killers after arthroplasty. Except this satisfaction rate was also higher among patients who received FICB. Keywords: Fascia iliaca block, Pain killer, Arthroplasty, Pain, Complications