Fascia Iliaca vs. Combined Iliaca Blocks for Proximal Hip Fractures in the Emergency Department

Introduction: Over 335,000 adults are hospitalized annually for proximal hip fractures, with the incidence of these injuries increasing as the population ages. Our objective in this study was to compare pain scores of patients with proximal hip fracture 30 minutes after undergoing a combined fascia iliaca plus femoral nerve block vs standard fascia iliaca block. Methods: We performed a retrospective cohort study including all isolated proximal hip fracture patients > 18 years of age who underwent regional anesthesia by ultrasound fellowship-trained emergency physicians in a community hospital emergency department between January 1, 2022– September 26, 2024. We excluded patients with distal femur fractures, those who had received additional pain medications within 30 minutes of the block, or those who could not reliably relay a pain score. The primary outcome was subjective pain scores (scale 1-10) after undergoing regional anesthesia. Results: Of 89 patients who underwent regional anesthesia for proximal hip fracture, 20 were excluded. A total of 31 fascia iliaca blocks and 38 combined blocks were performed. Patient age, weight, and pre-procedure pain scores were similar between the groups. Females were more predominant in the fascia iliaca block group (67.7% vs 42.1%; P = .03). On average, patients who received the combined block rated their post-procedure pain score 1.4 points lower than those who received a fascia block (3.8 vs 5.2/10, P = .01). This finding was consistent when controlling for sex and pre-procedure pain scores (β: 1.5; 95% CI, 0.6-2.4). Conclusion: Undergoing combined fascia iliaca plus femoral nerve block was associated with lower pain scores after 30 minutes compared to isolated fascia iliaca block in patients with proximal hip fractures. These patients may benefit from using this single-injection procedure for improved pain control.