Barriers to Routine Use of Ultrasound-Guided Fascia Iliaca Blocks in High and Low-Resource Emergency Departments

BackgroundUltrasound-guided regional anesthesia, such as fascia iliaca (FI) blocks, represents an alternative pain management strategy with decreased risk of oversedation and respiratory depression for emergency department patients. MethodologyThis is a two-site, descriptive, 12-month follow-up survey to evaluate FI block uptake and perceived barriers after training resident physicians at two academic training sites: an urban academic tertiary center in the United States and a resource-limited referral hospital in Malawi. ResultsIn total, 34 participants from the US site and seven participants from the Malawi site completed the survey, with response rates of 87% and 28%, respectively.Nearly all participants agreed that FI blocks were useful and improved patient care (median = 4 on a five-point Likert scale), and the majority reported confidence in performing the procedure.Despite this, most participants had not performed an FI block in the preceding 12 months (62% US participants and 57% Malawian participants).Perceived barriers were rated with "time to perform the procedure" ranking the highest among US participants and "time to perform the procedure" and "patient disinterest/refusal" ranking the highest for Malawian participants.Lack of equipment or supervision was commonly noted as a reason Malawian participants had considered but not performed an FI block, but not for US participants.Patient comorbidities (25%) and orthopedic reluctance (20%) were reasons US participants had considered but not performed the procedure, but were not noted by Malawian participants. ConclusionsReported barriers varied according to location, and the findings suggest that barriers are multifactorial and highly context-dependent.