{"pk":597,"title":"Fascia Iliaca Compartment Block Efficacy in Resource-poor Emergency Departments","subtitle":null,"abstract":"Introduction:\n Although the fascia iliaca compartment block (FICB) seems to be an ideal technique for femoral neck and shaft fractures occurring in resource-poor settings, it has been unclear how effective it is when used by emergency physicians (EP) with little training in the technique, using equipment, medications and methods that differ from those commonly available in developed countries. This series was designed to demonstrate that EPs in a resource-poor setting can provide effective analgesia for femur fractures with anatomic landmark-guided FICBs, clinician-compounded lidocaine-epinephrine (1:100,000), and a standard injection needle.\nMethods:\n Over a three-month period, patients ≥12 years old presenting to the emergency department with hip or femur fractures and a Likert visual analogue scale >4 had an EP-administered FICB. EPs used a standard intramuscular needle and a lidocaine-epinephrine solution they compounded at the bedside and located the injection site using only anatomic landmarks. EPs evaluated the patient’s pain level at 30 minutes and at two hours post-FICB. We also reviewed articles since 2016 that describe the FICB.\nResults:\n We enrolled a non-consecutive sample of 10 patients in the case series. Five had femoral neck (hip) fractures and five had femoral shaft fractures. All patients had a reduction in their pain levels after the FICB. On average, the block took effect about three minutes after injection. At 30 minutes all patients reported clinically meaningful pain reduction. The analgesic effect of the compounded agent lasted approximately 200 minutes. No adverse effects were reported. No published journal articles about FICB since 2016 were from resource-poor settings, and only one was from a developing country.\nConclusion:\n This series suggests that the FICB is effective even when performed with the minimal materials that are usually available in resource-poor settings. Methods such as this, which use simplified clinical tests and techniques applicable in resource-poor settings, can assist global emergency medicine (EM). We can assist global EM by similarly finding methods to simplify useful clinical tests and techniques that can be used in resource-poor settings.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Series","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3qk361jb","frozenauthors":[{"first_name":"Daniel","middle_name":"","last_name":"St. Louis","name_suffix":"","institution":"Georgetown Public Hospital, Department of Accident and Emergency Medicine, Georgetown, Guyana","department":"None"},{"first_name":"Kenneth","middle_name":"V.","last_name":"Iserson","name_suffix":"","institution":"Georgetown Public Hospital, Department of Accident and Emergency Medicine, Georgetown, Guyana\nUniversity of Arizona, Department of Emergency Medicine, Tucson, Arizona","department":"None"},{"first_name":"Nicolas","middle_name":"","last_name":"Forget","name_suffix":"","institution":"Vanderbilt University, Department of Emergency Medicine, Nashville, Tennessee","department":"None"}],"date_submitted":"2018-09-18T15:07:18-07:00","date_accepted":"2018-09-18T15:07:18-07:00","date_published":"2018-09-28T13:13:06-07:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/597/galley/358/download/"}]}