Abstract
The Iliaca Fascia block (IFB) is a crucial regional anaesthetic technique primarily used for providing analgesia in Femoral Fractures. The block targets the femoral, lateral femoral cutaneous, and obturator nerves by depositing local anaesthetic beneath the Fascia Iliaca. The British Orthopaedic Association Standards for Trauma (BOAST) guidelines for management of neck of femur fractures recommend "offering immediate and regular analgesia on presentation”
Our Primary aim was to assess whether the block has been completed. If not completed; was a rationale/contraindication appropriately documented? Our Secondary aims were to assess who the blocks were being done by, assess whether observations after block were documented and to assess whether pain scores before and after were documented.
Our Methods included data collection over 3 months from 10/02/25 to 10/05/2025 for all patients presenting with neck of femur fractures to Scarborough General Hospital.
Data sources included our internal IT system, trauma lists, paper notes, Emergency department documentation and scanned patient letters.
We found that within our cohort over 50% were 80+ year olds. Altered mental status and multiple comorbidities were frequent. Nearly 1/3 of hip fracture patients did not receive IFB. The rationale for not blocking is infrequently documented – which is a lack of widely recognised best practice. Pain score documentation is rarely done which meant that efficacy of intervention is unclear. However, consent for block is done regularly with consent documented in 90% of cases.
We suggest that if IFB is contraindicated, good documentation of mitigation should be made: reason to not block, pain score, alternative analgesia offered.
Ongoing education regarding accessibility and effectiveness of IFB should be given to Orthopaedic and ED staff
Of note already is that ED operates on the IT system yet IFB documentation is paper based which can be an improvement point to make a more coherent system
Comments
Question
Hello. Thank you for presenting your work. what would you propose could be done to encourage ED colleagues to improve documentation regarding IFBs, especially when decision made not to perform this?
Hello, Did you find there…
Hello,
Did you find there was a difference in documentation depending on what grade of clinician completed the IFB (e.g. SHO/ ACP/ Reg)?
Reply to the questions
Now we have new A&E department in SGH , most of the staff are aware of the importance for IFB .
As that allows 12 hours of pain free in patients with fracture femur
No there was no difference in the documentation on what grade of clinician completed the IFB