Improving Presurgical Pain Management of the Hip Fracture Patient Via Adoption of an Evidence-Based Recommendation for Ultrasound-Guided Fascia Iliaca Block

Abstract

Hip fracture patients traditionally have had their pain managed using parenteral medications such as opioids, which inadequately manage pain and lead to inferior outcomes (Cowan, Lim, Ong, Kumar, & Sahota, 2017). Ultrasound-guided regional anesthesia has emerged as an evidence-based therapy that improves the care of patients experiencing a hip fracture. This project sought to update a clinical practice guideline (CPG) by the American Academy of Orthopaedic Surgeons (AAOS) that strongly recommends the use of preoperative regional anesthesia to manage hip fracture pain. The updates to the CPG were obtained using a literature review and stakeholder interviews. The revisions included which type of block (the fascia illiaca compartment block), how to administer the block (under ultrasound guidance,) and other smaller details surrounding regional anesthesia in the hip fracture patient. Following the expansion to the CPG, anesthesia providers evaluated the quality of this new guideline using a validated tool, the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument. The reviewers found the revised CPG from the author to be an appropriate recommendation and ready for implementation into practice.