Parallel Session A

Fascia iliaca blocks for fractured neck of femur – a nurse-led service

Biography
Lynn Grigg is the lead pain nurse for The Luton & Dunstable Hospital NHS Trust.

Lynn qualified in 1996 coming late to nursing.  She spent some years in a medical ward gaining a junior and later a senior sisters’ post.  In 2001, the opportunity arose to set up the Pain Service at the Luton and Dunstable Hospital with Dr Indra Srikantharajah, Consultant Anaesthetist.  Lynn attended Leicester University and gained an MSc in Pain Management in 2006.

Since then the service has developed rapidly with many barriers faced and overcome.  The original Acute Pain Service is now fully integrated to include all aspects of pain, covering all areas of the hospital including A & E, children, labour ward, imaging departments, outpatients, pain management programmes and chronic pain clinics.  This proved a huge task for one pain nurse and in 2006 Adrianne Randall, anaesthetic sister, joined the team.

Around the same time Dr Srikantharajah had an idea that nurses could be taught to administer a fascia iliaca compartment block.  This view was supported by specialist anaesthetic registrar, Dr Obideyi Ayodele and it therefore became a joint venture.  The pain nurses were the first to be taught and they cascaded the training to other non-anaesthetists and nurses.  Following the enormous success of the project, the team has been asked to present world-wide including Hong Kong, South Africa, Montreal, Munich, Malta and more locally in Scotland, Wales and North and South England.

Abstract
The feasibility of offering patients a fascia iliaca compartment block for pain relief, in the pre-operative period following a fractured neck of femur, was considered at our hospital.  It became clear that anaesthetists could not take on this role.  Therefore the Consultant Anaesthetic Lead for Acute Pain, Dr Srikantharajah, suggested that nurses and non-anaesthetists could be trained to do the block.  Subsequently, she trained the Pain Nurses.  This training was later extended to include orthopaedic and A & E nurses. A & E doctors and junior orthopaedic doctors were also trained.  However, predominantly, our training efforts concentrated on nurses as they tend to stay in the Trust longer than the doctors.
Auditing the new service was essential in order to investigate the practicalities of training nurses to perform the block.  Our on-going audit evaluates the safety, efficacy and feasibility of its use.
Following the preliminary findings of the audit, the Luton & Dunstable Hospital NHS Trust (UK) developed a treatment guideline for the management of pain in #NOF.  The novel advancement in the guideline is the inclusion of a fascia iliaca compartment block to be given by non-anaesthetists.
Some hospitals have instituted a femoral nerve block to be given by specialist pain nurses and non-anaesthetists.  However, the fascia iliaca compartment block has a greater margin of safety than a femoral block, as the needle is inserted at a distance lateral to the femoral neurovascular bundle, therefore, registered general nurses from A & E, orthopaedics and care of the elderly departments, can be trained to perform it.  This increases the numbers of patients that can benefit.  In our hospital nurses are trained in patient selection, consent, performing the block and the management of possible complications.
Our audit shows that a fascia iliaca compartment block provides pain relief in more than 70% of cases and post block opioid requirements are reduced.  It demonstrates that non-anaesthetic personnel can perform the block safely and successfully, resulting in more patients receiving improved pain management in the pre-operative period.  No complicated equipment is required and complications are uncommon thus making it an appealing pain relief technique for this group of patients.
References
Obideyi A, Srikantharajah I, Grigg L, Randall A. Nurse Administered fascia iliaca compartment block for pre-operative pain relief in adult fractured neck of femur. Acute pain journal 2008: Vol 10: 145-149
Randall A, Grigg L, Obideyi A, Srikantharajah I. Fascia Iliaca compartment block: a nurse-led initiative for preoperative pain management in patients with a fractured neck of femur. Journal of Orthopaedic Nursing 2008: Vol 12: 69-74