Hip fractures are common and the incidence is expected to increase. Systemic analgesics, often prescribed to relieve pain after hip fractures, have huge side effects and can delay surgery. We analyse the role and efficacy of alternative forms of analgesia like fascia-iliac blocks (FIB) and assess the feasibility of a service delivered by junior doctors. 104 consecutive hip fracture patients were prospectively recruited and equally divided into cases (patients receiving FIB) and controls (patients receiving systemic analgesia). Outcome measures included time of initial analgesia, total preoperative dose of analgesia, pain scores from admission to 24 hours preoperatively, and complications. The pain scores were significantly lower ( ) in patients receiving FIB at 2 and 8 hours preoperatively. The timing of initial analgesia was also quicker in patients with FIB (25 compared to 40 minutes). FIB patients required fewer doses of systemic analgesia. The block was successful in 67% of patients. There were no complications. The implementation of EWTD, HAN, and shift-system and the reduction in the number of medical staff have increased the burden on emergency departments. This study demonstrates that FIB performed by junior doctors are not only safe and effective analgesia but also provide an opportunity for junior doctors to improve current clinical practice. 1. Introduction About 75,000 hip fractures occur annually in the United Kingdom [1] often as the result of trivial injury. The incidence of these “fragility fractures” is expected to increase to 91,500 by 2015 and 101,000 in 2020 [2] with people >85 years which are 10–15 times more likely to sustain hip fractures than people aged 60 to 65 years [3]. The seriousness of hip fractures is reflected by the 23-day postoperative hospital stay and 10% 30-day mortality, associated with an annual cost of medical and social care amounting to nearly ￡2 billion. These figures are multifactorial and are in part due to the complications that occur after a hip fracture in a population group with significant comorbidities (median ASA grade 3) [4]. Hip fractures are painful and inadequately controlled pain can have significant physiological and psychological effects [5] such as an acute confusional state (delirium) seen in 10–16% of hip fracture patients presenting to emergency department (ED) [6]. These factors make further pain assessment difficult and have the potential to delay surgical intervention, compound complications, and ultimately prolong hospital stay and increase the risk of nursing home placement [7]. The
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