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Papers of the Week

2022 Aug 17




Clinical and cost-effectiveness of paramedic administered fascia iliaca compartment block for emergency hip fracture (RAPID 2)-protocol for an individually randomised parallel-group trial.


Kingston M, Jones J, Black S, Evans B, Ford S, Foster T, Goodacre S, Jones M-L, Jones S, Keen L, Longo M, Lyons RA, Pallister I, Rees N, Siriwardena A N, Watkins A, Williams J, Wilson H, Snooks H
Trials. 2022 Aug 17; 23(1):677.
PMID: 35978361.


Approximately 75,000 people fracture a hip each year in the UK. This painful injury can be devastating-with a high associated mortality rate-and survivors likely to be more dependent and less mobile. Pain relief at the scene of injury is known to be inadequate. Intravenous morphine is usually given by paramedics, but opioids are less effective for dynamic pain and can cause serious side effects, including nausea, constipation, delirium and respiratory depression. These may delay surgery, require further treatment and worsen patient outcomes. We completed a feasibility study of paramedic-provided fascia iliaca compartment block (FICB), testing the intervention, trial methods and data collection. The study (RAPID) demonstrated that a full trial was feasible. In this subsequent study, we aim to test safety, clinical and cost-effectiveness of paramedic-provided FICB as pain relief to patients with suspected hip fracture in the prehospital environment.