Luton and Dunstable University Hospital, England
Title: Fascia iliaca compartment block: A nurse-led initiative for preoperative pain management in patients with a fractured neck of femur
Adrianne Randall has qualified as a Registered General Nurse in New Zealand in 1977 and has specialized in Accident and Emergency Nursing. In 2005, she joined the Pain Team in a part time capacity and soon after obtained a BA using the development of the “Fascia iliaca compartment block: a nurse-led service” as the basis for her dissertation and consequent publication. She continues to work in both Anesthetics and Pain Management, having recently completed the Non-medical Prescribing Course and is currently developing the role of Nurse Sedationist.
Having investigated the efficacy, feasibility, safety and cost complications of using the little known “fascia iliaca compartment block” as a method of pain relief, the Pain Management Team at the Luton and Dunstable Hospital pioneered a nurse-led service, providing effective long acting pain relief in the preoperative period, for patients who had sustained a fractured neck of femur, consequently improving their quality of life by reducing pain and the additional complications such as chest infection, pressures sored and deep vein thrombosis, due to a lack of mobility whilst awaiting surgery. Fractured neck of femur is a serious and costly injury affecting mainly elderly population, which causes considerable pain when untreated or undertreated. The fascia iliaca compartment block for pain relief, provides an additional margin of safety because the needle is inserted distally to the femoral neurovascular bundle. It was therefore felt that nonmedical personnel could be taught to perform the block, enabling more patients to benefit from improved pain management and a reduction in the concurrent use of systemic opioids, thereby decreasing the incidence of opioid induced confusion in the target group and facilitating better nursing care. Specialist nurses were given the requisite training in patient selection, consent, performing the block and the management of possible complications.