Pamela Hands
18 Dec 2017 · Coroner Emma Carlyon · Cornwall and the Isles of Scilly
A similar concern from this report was raised again 1 time later. See the linked reports.
The coroner's concerns
1. respiratory depression from opioid toxicity after fascia iliac block
“The Expert Consultant in Pain Medicine explained that after the fascia iliac block was administered analgesia will occur over 10-15 minutes. As the patient obtains better analgesia from the fascia iliac block, the opioids in the circulation would have a more toxic effect than an analgesic effect. Pain is a potential arousal stimulus keeping the patient awake and aware of their surroundings. Pain is also a respiratory stimulant. There is an intimate link”
2. lack of national guidelines for post-procedure monitoring after nerve block
“At the time of the death were no National Guidelines to advise on the need to monitor patients post procedure or application of the anaesthetic nerve block”
3. lack of awareness of opioid toxicity risk with nerve block
“At inquest it was clear from the evidence of the Clinical Director of Emergency Medicine that in 2015 the effect of relative opioid toxicity following the administration of a local anaesthetic nerve block for proximal femur fractures was not widely recognised within Emergency Medicine. As there was an increase in the use of fascia iliac block in conjunction with opioid analgesia in emergency medicine, this risk should be highlighted to health professionals so that they were aware of the risk and”
Linked reports
Closely relatedConfidence 0.80 · moderate
This report
“At the time of the death were no National Guidelines to advise on the need to monitor patients post procedure or application of the anaesthetic nerve block”
Later report
“that consideration to the creation of appropriate national guidelines in respect of the implementation of any New Interventional Procedure programme and the training required in respect thereof should be considered.”
Responses
2017-0373-Response-by-British-Orthopaedic-Association.pdf ↗· Royal College of Emergency Medicine
Stated action · within the next 12months
“covers the management of hip fractures will be updated to reflect and emphasise the need for appropriate monitoring of all patients particularly those in pain pre or post procedure. This document is due for renewal within the next 12months.”