None listed
Conditions
Brief summary
We are examining pain management in those patients who present to the emergency department with a fractured hip. Current practice in St Vincent's hospital emergency department is regular paracetamol and parenteral morphine. The POTENTIAL side effects of morphine are well known particularly in the older age group and include such effects as: drowsiness and/or confusion; nausea and vomiting; clinical significant slowing of breathing and lowering of blood pressure. Particular in those who receive significant amounts of morphine. Our aim is to show that patients who receive an ultrasound guided femoral nerve block AS PART OF their pain control management will require clinically significant less morphine than those who do not. In fact we are hoping to show these patients use 50% less morphine. If this is the case we will be supporting the idea of introducing ultrasound guided femoral nerve blocks to current clinical practice guidelines for managing pain in fractured hips.
Interventions
An ultrasound guided femoral nerve block will be placed using 1% ropivacaine. We are testing it's ability to provide pain control for patients with fractured neck of femurs.
Any emergency registrar or consultant who has been enlisted as an investigator and has undergone the training session is able to enrol patients and administer the block. After written informed consent has been obtained by the patient the groin area is prepared with sterile technique. An ultrasound vascular probe is placed to
An ultrasound guided femoral nerve block will be placed using 1% ropivacaine. We are testing it's ability to provide pain control for patients with fractured neck of femurs. Any emergency registrar or consultant who has been enlisted as an investigator and has undergone the training session is able to enrol patients and administer the block. After written informed consent has been obtained by the patient the groin area is prepared with sterile technique. An ultrasound vascular probe is placed to locate structures anatomically: the main structures being the femoral nerve itself, the femoral artery and vein, the fascia iliaca. Then under real time ultrasound guidance via an out of plane approach 15ml of 1% ropivacaine is injected around the femoral nerve as visualised. A two person technique is employed with the needle attached to the syringe of ropivacaine via a 90cm minimum volume extension set. There is the probe and needle operator and the an assistant injecting the anaesthetic. Digital pressure is then placed for 30 seconds just distal to the injection site. The entire procedure takes about 15 to 20 minutes. Objective measure of the nerve block is assessed at 30 minutes by testing sensation over the anterolateral aspect of the thigh.
Sponsors
St Vincents
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Radiological proof of a fractured neck of femur.
Exclusion criteria
1. Women lactating, pregnant or of childbearing potential who are not willing to avoid becoming pregnant during the study. 2. <18years old. 3. Allergy to ropivacaine. 4. Allergy to paracetamol and morphine. 5. Anticogulated patients or those with significant coagulation abnormalities that increase their risk of bleeding. 6. localized injection site infections. 7. neurological deficits in the distribution of the femoral nerve noted. 8. Consent denied. 9. Documented severe hepatic disease patient is unable to give consent themselves. 10. patients with a history of heart block or who are on amiodarone 11. patients who have had an acute cardiac event in the last 3 months.
Outcome results
None listed