Hip fracture Postoperative pain Intertrochanteric fracture Femoral neck fracture Hip fractures Peripheral nerve block Dexamethasone Fascia iliaca compartment block Postoperative analgesia Bupivacaine Randomized controlled trial Old Aged
Conditions
Interventions
Intravenous dexamethasone 8 mg (2 mL) single dose, administered by unblinded research nurse immediately after confirmed successful ultrasound-guided suprainguinal fascia iliaca compartment block with
Experimental Drug,Placebo Comparator Drug
Intravenous dexamethasone,Intravenous normal saline (placebo)
Sponsors
Nattapong Tanghor
Eligibility
Sex/Gender
All
Age
60 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Age 60 years and older, both sexes 2. Body weight 45 kg or more 3. Diagnosed hip fracture (intertrochanteric or femoral neck) confirmed by plain radiograph 4. ASA physical status class I to III 5. Scheduled for hip fracture surgery under spinal anesthesia combined with suprainguinal fascia iliaca compartment block 6. Able to provide written informed consent independently 7. Able to cooperate with Verbal Rating Scale and QoR-14-Thai assessment
Exclusion criteria
Exclusion criteria: 1. Known allergy to amide-type local anesthetics or dexamethasone or corticosteroids 2. Local infection at block injection site 3. Coagulopathy: PT/INR greater than 1.5 or platelet count less than 80000/mm3 or receiving anticoagulation that cannot be withheld 4. Pre-existing peripheral neuropathy or neurological deficit in the operative limb 5. Chronic opioid use or opioid dependence 6. Uncontrolled diabetes mellitus: HbA1c greater than 8% within 3 months preoperatively or preoperative blood glucose greater than 200 mg/dL 7. Dementia or severe cognitive impairment precluding VRS and QoR-14-Thai assessment 8. Body weight less than 45 kg 9. BMI greater than 40 kg/m2 10. Contraindication to spinal anesthesia 11. eGFR less than 30 mL/min/1.73m2 or receiving renal replacement therapy 12. Uncontrolled hypertension: preoperative SBP 180 mmHg or more or DBP 110 mmHg or more despite standard preoperative management 13. History of dyspepsia, active peptic ulcer, or upper GI bleeding within 6 months 14. Refusal to participate
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Time to first rescue analgesia Up to 24 hours after block Time (minutes) from block to first rescue analgesia/ Kaplan-Meier with log-rank test; Cox regression | — |
Secondary
| Measure | Time frame |
|---|---|
| Verbal rating scale (VRS) At PACU, 6, 12, and 24 hours after block Verbal Rating Scale (0 to 4)/ Mann-Whitney U test,Cumulative opioid consumption 24 hours after block Total morphine equivalent (mg)/ Mann-Whitney U test,Quality of recovery 24 hours after block QoR-14-Thai score (0 to 140)/ Mann-Whitney U test,Complications 24 hours after block Incidence of adverse events/ Chi-square or Fisher exact test,Capillary blood glucose 6 and 24 hours post-study drug Glucometer measurement (mg/dL)/ descriptive statistics and Mann-Whitney U test | — |
Countries
Thailand
Contacts
Public ContactNattapong Tanghor
Thabo Crown Prince Hospital
Outcome results
None listed