Hip Fractures
Conditions
Brief summary
A higher number than expected of patients with hip fracture have only insufficient analgesic effect of a femoral nerve block, which is the nerve block commonly used for this group of patients. One of the possible causes of this failure to provide analgesia from a single nerve block could be the that other nerves are involved in transmitting the pain signal. One of the nerves that is believed to give off branches to the hip is the obturator nerve. With ultrasound it is possible to make a selective proximal nerve block of the obturator nerve. The aim of this trial is to test the analgesic effect of a femoral nerve block i combination with an obturator nerve block compared to femoral nerve block alone in a randomized and placebo controlled design.
Detailed description
A higher number than expected of all patients with hip fracture have only insufficient analgesic effect of a femoral nerve block. One of the possible causes of this failure to provide analgesia from a single nerve block could be the that other nerves are involved in transmitting the pain signal. One of the nerves that is believed to give off branches to the hip is the obturator nerve. Earlier it was believed that the so called '3-in-1-block' or the iliac fascia compartment block would anesthetize also the obturator nerve, and these two nerve blocks have been uses extensively in the emergency ward for preoperative analgesia. Today that is not believed to be true and consequently is the part of the obturator nerve in patients with hip fracture unknown. With ultrasound it is possible to make a selective proximal nerve block of the obturator nerve before it branches into an anterior and a posterior branch. A selective nerve block of the obturator nerve to access its effect in patients with hip fracture has to our knowledge never been done. The aim of this trial is to test the analgesic effect of a femoral nerve block i combination with an obturator nerve block compared to femoral nerve block alone in a randomized and placebo controlled design.
Interventions
DRUGBupivacaine
Obturator nerve block
DRUGSaline
Obturator nerve block with saline(placebo)
Sponsors
University of Aarhus
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Clinical suspicion of hip fracture * Age ≥ 55 years * Mentally capable of comprehending and using verbal pain score * Mentally capable of differentiating between pain from the fractured hip and pain from other locations * Mentally capable of understanding the given information * Arrival in the emergency room at times when one of the doctors who do the nerve blocks for this investigation are on call * Verbal numeric pain scale score (NRS 0-10) \> 5 with a dynamic test OR NRS \> 3 at rest * Patients informed consent
Exclusion criteria
* Hip fracture not confirmed by x-ray * Weight \< 40 kg * Patient has previously been included in this trial * If the patient wishes to be excluded * Allergy to local anesthetics or adrenocortical hormone * Visible infection in the area of the point of needle injection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success rate of successful analgesia, measured with numeric rating scale(NRS) 0-10 with 0=no pain and 10=worst pain. Successful analgesia = NRS<4 at rest and NRS <6 with passive movement of the fractured leg. | 30 minutes | Success rate of successful analgesia compared between the groups |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Median change in pain score (NRS 0-10) | 30 minutes | Median change in pain score 30 minutes after the nerve blocks compared between the groups |
| Course in pain reduction | 30 minutes | Course in pain reduction during the 30 minutes after the nerve blocks |
| Time to sufficient analgesia | 30 minutes | Time from ended injection until sufficient analgesia |
| Frequency of anesthesia in the skin area of the saphenous nerve | 30 minutes | Frequency of anesthesia in the skin area innervated by the saphenous nerve |
| Frequency of anesthesia in the skin area of the anterior cutaneous branches of the femoral nerve | 30 minutes | Frequency of anesthesia in the skin area of the anterior cutaneous branches of the femoral nerve |
| Localization of the worst pain before block | 0 minutes | Localization of the worst pain before any nerve blocks |
| Localization of the worst pain after block | 30 minutes | Localization of the worst pain 30 minutes after the nerve blocks |
| Discomfort during nerve block procedures (score 0-10, 0=no discomfort) | 5 minutes | Discomfort during the nerve block procedures compared between procedures |
| Median pain score (NRS 0-10) | 30 minutes | Median pain score 30 minutes after the nerve blocks compared between the groups |
| Frequency of ultrasound visualization of femoral nerve | 5 minutes | Frequency of patients with possible ultrasound visualization af the femoral nerve |
| Frequency of ultrasound visualization of obturator injection site | 5 minutes | Frequency of patients with possible ultrasound visualization of the obturator nerve block injection site |
| Time spend on femoral nerve block | 5 minutes | Time spend on conducting the femoral nerve block |
| Time spend on obturator nerve block | 5 minutes | Time spend on conducting the obturator nerve block |
| Total morphine equivalent dose of opioid from the time of nerve block to operation | Approximately 24 hours in average | Total morphine equivalent dose of opioid from the time of nerve block until the time of operation |
| Total morphine equivalent dose of opioid/time from the time of nerve block to operation | Approximately 24 hours in average | Total morphine equivalent dose of opioid/time from the time of nerve block until the time of operation |
| Total morphine equivalent dose of opioid in the first 10 hours after nerve block | 10 hours | Total morphine equivalent dose of opioid given in the first 10 hours after nerve block |
| Total morphine equivalent dose of opioid/time in the first 10 hours after nerve block | 10 hours | Total morphine equivalent dose of opioid/time given in the first 10 hours after nerve block |
| Satisfaction (0-10, 0= very unsatisfactory) | 30 minutes | Patient satisfaction with the pain treatment |
Countries
Denmark
Contacts
Primary ContactThomas D. Nielsen, M.D.
Backup ContactThomas F. Bendtsen, Ph.d.
Outcome results
None listed