{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:46:43Z","timestamp":1792118803582,"version":"4.4.0"},"reference-count":27,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2022,3,28]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Until recently, systemic opioids have been standard care for acute pain management of geriatric hip fracture; however, opioids increase risk for delirium. Fascia Iliaca compartment blocks (FICB) may be favored to systemic analgesia for reducing delirium, but this has not been well demonstrated. We evaluated the efficacy of adjunctive FICB versus systemic analgesia on delirium incidence, opioid consumption, and pain scores.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This prospective, observational cohort study was performed in patients (55\u201390 years) with traumatic hip fracture admitted to five trauma centers within 12 hours of injury, enrolled between January 2019 and November 2020. The primary end point was development of delirium, defined by the Confusion Assessment Method tool, from arrival through 48 hours postoperatively, and analyzed with multivariate Firth logistic regression. Secondary end points were analyzed with analysis of covariance models and included preoperative and postoperative oral morphine equivalents and pain numeric rating scale scores.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 517 patients enrolled, 381 (74%) received FICB and 136 (26%) did not. Delirium incidence was 5.4% (n=28) and was similar for patients receiving FICB versus no FICB (FICB, 5.8% and no FICB, 4.4%; adjusted OR: 1.2 (95%\u2009CI 0.5 to 3.0), p=0.65). Opioid requirements were similar for patients receiving FICB and no FICB, preoperatively (p=0.75) and postoperatively (p=0.51). Pain scores were significantly lower with FICB than no FICB, preoperatively (4.2 vs 5.1, p=0.002) and postoperatively (2.9 vs 3.5, p=0.04).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>FICB demonstrated significant benefit on self-reported pain but without a concomitant reduction in opioid consumption. Regarding delirium incidence, these findings suggest clinical equipoise and the need for a randomized trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>II\u2014prospective, therapeutic.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2022-000904","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T11:10:19Z","timestamp":1650021019000},"page":"e000904","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture"],"prefix":"10.1136","volume":"7","author":[{"given":"Kristin","family":"Salottolo","sequence":"first","affiliation":[{"name":"Trauma Research Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Meinig","sequence":"additional","affiliation":[{"name":"Orthopedic Services Department, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Landon","family":"Fine","sequence":"additional","affiliation":[{"name":"Orthopedics Department, Parker Adventist Hospital, Parker, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kelly","sequence":"additional","affiliation":[{"name":"Orthopedic Services Department, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Madayag","sequence":"additional","affiliation":[{"name":"Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francie","family":"Ekengren","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Wesley Medical Center, Wichita, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Tanner","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Roman","sequence":"additional","affiliation":[{"name":"Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3685-314X","authenticated-orcid":false,"given":"David","family":"Bar-Or","sequence":"additional","affiliation":[{"name":"Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,15]]},"reference":[{"key":"2025081711075440000_7.1.e000904.1","unstructured":"National Center for Health Statistics . Trends in health and aging. Hyatsville, MD: US Department of Health and Human Services, 2006."},{"key":"2025081711075440000_7.1.e000904.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-015-0140-y","article-title":"The effect of early surgery after hip fracture on 1-year mortality","volume":"15","author":"Colais","year":"2015","journal-title":"BMC Geriatr"},{"key":"2025081711075440000_7.1.e000904.3","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2013.878831"},{"key":"2025081711075440000_7.1.e000904.4","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.2106\/JBJS.16.01133","article-title":"Effect of surgeon and hospital volume on morbidity and mortality after hip fracture","volume":"99","author":"Okike","year":"2017","journal-title":"J Bone Joint Surg Am"},{"key":"2025081711075440000_7.1.e000904.5","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afq140"},{"key":"2025081711075440000_7.1.e000904.6","doi-asserted-by":"publisher","DOI":"10.1177\/2151458516641162"},{"key":"2025081711075440000_7.1.e000904.7","doi-asserted-by":"crossref","first-page":"228","DOI":"10.5312\/wjo.v10.i6.228","article-title":"Delirium after emergency hip surgery - common and serious, but rarely consented for","volume":"10","author":"Koizia","year":"2019","journal-title":"World J Orthop"},{"key":"2025081711075440000_7.1.e000904.8","doi-asserted-by":"crossref","first-page":"421","DOI":"10.2147\/CIA.S115945","article-title":"Dementia and delirium, the outcomes in elderly hip fracture patients","volume":"12","author":"Mosk","year":"2017","journal-title":"Clin Interv Aging"},{"key":"2025081711075440000_7.1.e000904.9","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.O.00229"},{"key":"2025081711075440000_7.1.e000904.10","first-page":"CD001159","article-title":"Peripheral nerve blocks for hip fractures","volume":"5","author":"Guay","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025081711075440000_7.1.e000904.11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-4-201108160-00346"},{"key":"2025081711075440000_7.1.e000904.12","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-012-9880-8"},{"key":"2025081711075440000_7.1.e000904.13","unstructured":"National Center for Injury Prevention and Control . Opioid oral morphine milligram equivalent (MME) conversion factors. Atlanta, GA: Centers for Disease Control and Prevention, 2017 version."},{"key":"2025081711075440000_7.1.e000904.14","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1111\/jgs.14386","article-title":"Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial","volume":"64","author":"Morrison","year":"2016","journal-title":"J Am Geriatr Soc"},{"key":"2025081711075440000_7.1.e000904.15","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.annfar.2009.12.021","article-title":"[Influence of the fascia iliaca compartment block on postoperative cognitive status in the elderly]","volume":"29","author":"Perrier","year":"2010","journal-title":"Ann Fr Anesth Reanim"},{"key":"2025081711075440000_7.1.e000904.16","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1155\/2015\/872651","article-title":"Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture","volume":"20","author":"Nie","year":"2015","journal-title":"Pain Res Manag"},{"key":"2025081711075440000_7.1.e000904.17","doi-asserted-by":"crossref","first-page":"151","DOI":"10.5505\/agri.2014.76993","article-title":"Comparison of the postoperative analgesic efficacy of an ultrasound-guided fascia iliaca compartment block versus 3 in 1 block in hip prosthesis surgery","volume":"26","author":"Deniz","year":"2014","journal-title":"Agri"},{"key":"2025081711075440000_7.1.e000904.18","first-page":"167","article-title":"Efficacy and duration of ultrasound guided fascia iliaca block for hip fracture performed in the emergency departments","volume":"24","author":"Levente","year":"2017","journal-title":"Rom J Anaesth Intensive Care"},{"key":"2025081711075440000_7.1.e000904.19","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.bja.2017.12.042","article-title":"Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation","volume":"120","author":"Steenberg","year":"2018","journal-title":"Br J Anaesth"},{"key":"2025081711075440000_7.1.e000904.20","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000016157","article-title":"The efficacy of fascia iliaca compartment block for pain control after hip fracture: a meta-analysis","volume":"98","author":"Hong","year":"2019","journal-title":"Medicine"},{"key":"2025081711075440000_7.1.e000904.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-021-02150-9","article-title":"How does the multidimensional frailty score compare with grip strength for predicting outcomes after hip fracture surgery in older patients? A retrospective cohort study","volume":"21","author":"Choi","year":"2021","journal-title":"BMC Geriatr"},{"key":"2025081711075440000_7.1.e000904.22","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1302\/2633-1462.18.BJO-2020-0089.R1","article-title":"Clinical frailty scale is a good predictor of mortality after proximal femur fracture: a cohort study of 30-day and one-year mortality","volume":"1","author":"Narula","year":"2020","journal-title":"Bone Jt Open"},{"key":"2025081711075440000_7.1.e000904.23","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1111\/j.1532-5415.2012.04199.x","article-title":"Tools to detect delirium superimposed on dementia: a systematic review","volume":"60","author":"Morandi","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"2025081711075440000_7.1.e000904.24","doi-asserted-by":"crossref","unstructured":"Zucchelli A , Apuzzo R , Paolillo C . Development and validation of a delirium risk assessment tool in older patients admitted to the emergency department observation unit. Aging Clin Exp Res 2021 [published Online First: 2021\/02\/11.doi:10.1007\/s40520-021-01792-4","DOI":"10.1007\/s40520-021-01792-4"},{"key":"2025081711075440000_7.1.e000904.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-019-1266-0","article-title":"Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures - effects on cognition","volume":"19","author":"Wennberg","year":"2019","journal-title":"BMC Geriatr"},{"key":"2025081711075440000_7.1.e000904.26","doi-asserted-by":"publisher","DOI":"10.1007\/s10195-009-0062-6"},{"key":"2025081711075440000_7.1.e000904.27","doi-asserted-by":"crossref","first-page":"103151","DOI":"10.1016\/j.otsr.2021.103151","article-title":"The effect of regional nerve block on perioperative delirium in hip fracture surgery for the elderly: a systematic review and meta-analysis of randomized controlled trials","volume":"108","author":"Kim","year":"2022","journal-title":"Orthop Traumatol Surg Res"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2022-000904","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:08:08Z","timestamp":1755454088000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2022-000904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,4,15]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/tsaco-2022-000904"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2022-000904","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4]]}}}