None listed
Conditions
Brief summary
Significance of the study: Femoral fracture is an important clinical problem and is associated with high morbidity and mortality, especially in the elderly. Whilst opioids are the most commonly used analgesic by emergency medical services (EMS) there is some evidence that these may be inferior to alternate analgesic methods such as femoral nerve blocks. Studies to date have not evaluated the feasibility or effectiveness of paramedics performing this analgesic alternative. Alternatives like femoral nerve blocks could prevent complications of opioids although these agents are well tolerated and have a low complication rate when administered in this setting. The aim of this research is to assess the feasibility and efficacy of paramedics performing fascia iliaca compartment blocks (FICB) in the prehospital setting with adult patients with suspected or confirmed femoral fractures. The effectiveness of FICB will be compared to intravenous morphine.
Interventions
Anterior lumbar plexus nerve block (regional nerve block) known as a “fascia iliaca compartment block”.
This procedure involves a single insertion of needle in a specified anatomical location in the groin, distal to recognised neurovascular areas. A single bolus of local anaesthetic agent (Lignocaine 2% with Adrenaline 1:200 000) is injected slowly over 3 minutes into the potential space under the fascia iliaca and spread to anaesthetise the sensory nerves innervating the thigh. Dose weight dep
Anterior lumbar plexus nerve block (regional nerve block) known as a “fascia iliaca compartment block”. This procedure involves a single insertion of needle in a specified anatomical location in the groin, distal to recognised neurovascular areas. A single bolus of local anaesthetic agent (Lignocaine 2% with Adrenaline 1:200 000) is injected slowly over 3 minutes into the potential space under the fascia iliaca and spread to anaesthetise the sensory nerves innervating the thigh. Dose weight dependant : <70 Kg 300mg and >70 Kg 400mg. All patients consenting to partcipate in the study will receive a loading dose of 0.1 mg/Kg of morphine intravenously (I.V) in 2.5 mg aliquots.
Sponsors
New South Wales Health. Ambulance Service NSW
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
Adult patients (18+) with suspected femur fractures with moderate or severe pain (VNPS >4).
Exclusion criteria
Failure to give consent. Local infection at site. Major trauma. Cognitive impairment Known hypersensitivity to anaesthetic agent or antidote. Currently on oral anticoagulants – warfarin Inability to identify landmarks ( i.e. obesity / pregnancy) Estimate weight < 50 kg Pre-existing nerve injury.
Outcome results
None listed