Analgesia, Hip Fractures, Nerve Block
Conditions
Brief summary
This study is a prospective, randomized clinical trial assessing the efficacy of physician-performed ultrasound-guided pericapsular nerve group (PENG) block vs fascia iliaca compartment (FIC) block for pain control in acute hip fracture.
Interventions
PROCEDUREPericapsular Nerve Group (PENG) Block
Under sterile technique, physician will identify relevant landmarks including the femoral artery, femoral vein, femoral nerve, ileopubic eminence (IPE), anterior inferior iliac spine (AIIS), psoas tendon (PT). Target area is bony space between AIIS and IPE adjacent to PT. Using in-plane technique with constant visualization, needle will be inserted through skin and soft tissue targeting fascial plane below the psoas tendon, above ilium bone. Landmark lies between the AIIS and IPE, just lateral to psoas tendon. As needle tip reaches target, small volume of normal saline will be injected to hydrodissect tissue. Fluid will start to spread along fascial plane, lifting the psoas tendon from ilium, confirming proper positioning. Normal saline will then be switched to anesthetic (30mL of Bupivacaine 0.25%). After full volume of anesthetic has been injected, a small volume (5mL) of normal saline will be injected to flush line of remaining anesthetic. Needle will then be withdrawn.
PROCEDUREFascia Iliaca Compartment (FIC) Block for Patients with Isolated Hip Fractures
Under sterile technique, physician will identify relevant landmarks, including femoral artery, femoral vein, femoral nerve, iliacus muscle with overlying fascia iliaca. Using in-plane technique with constant visualization, needle will be inserted through skin and soft tissue targeting the fascial plane above iliacus muscle. As needle tip reaches the target, a small volume of normal saline will be injected to hydrodissect tissue. Fluid will start to spread along fascial plane, confirming proper positioning. Normal saline will then be switched to anesthetic (30mL of Bupivacaine 0.25%). After full volume of anesthetic has been injected, a small volume (5mL) of normal saline will be injected to flush the line of remaining anesthetic. The needle will then be withdrawn.
Sponsors
Orange Park Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Masking description
The research associate/outcome assessor will not have access to group assignment and will therefore be blinded to the type of block. Although the patient, their caregiver(s), and the clinician caring for the patient will not be directly informed of the group assignment, a note will be logged in the clinical record by the physician placing the block indicating the details of the block after this procedure has been completed.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult (\>= 18 years of age) * Isolated proximal hip fracture (defined as Intertrochanteric or more proximal) as identified by X-ray, Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scan * Glasgow Coma Score (GCS) = 15 * Subjective pain score of \>= 5 on a scale of 0 to 10 just prior to the nerve block placement
Exclusion criteria
* Patients who are unable to give consent due to altered mental status or dementia * Clinically intoxicated patients * Patients who are unable to communicate their numeric level of pain * Open fracture or penetrating hip trauma * Signs of infection or laceration at injection site * Patients with multi-system trauma * Painful distracting injury (injury causing significant pain that distracts the patient from having reliable scoring of hip fracture pain, e.g. humerus fracture, dislocated joint) * Requiring immediate surgical intervention (\< 1 hour) * Deemed clinically unstable by treating physician * Abnormal vital signs (Pulse\>120bpm, Systolic blood pressure \< 100 mm Hg, Pulse O2 \< 95%) * Patients on long-acting systemic opioid analgesia * Allergy to amide local anesthetics * Vulnerable populations including pregnant patients, prisoners, children, elderly dementia patients. All precautions will be taken to avoid coercion, harm and exploitation of these vulnerable populations, thus they are to be excluded from this study. They will receive pain medications as deemed appropriate by their treating physician.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Numeric pain score at 30 minutes | 30 minutes after block placement |
| Numeric pain score at 60 minutes | 1 hour after block placement |
Secondary
| Measure | Time frame |
|---|---|
| Cumulative Morphine Milligram Equivalents in 24 hours after enrollment | 24 hours after enrollment |
Contacts
Primary ContactTaryn Hoffman, MD
Outcome results
None listed