Trial of Ultrasound Guided Femoral Nerve Block on Isolated Femur Fracture Using Echo Friendly Needles

NCT ID: NCT02046317

Last Updated: 2018-12-07

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-05-31

Study Completion Date

2016-11-30

Brief Summary

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This study aims to determine if there is any difference in the success rate of ultra-sound guided femoral nerve block performed with an echogenic needle versus a standard needle.

Detailed Description

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To date, the published information regarding ultrasound guided femoral nerve blocks (FNB) using echo friendly needle is very limited. More so, there is even less information regarding ultrasound guided nerve blocks using echogenic versus standard of care needles.

This study hopes to add to the general knowledge of pain management in the emergency department (ED) setting and provide a unique perspective on ultrasound-guided techniques using echogenic needles to enhance accuracy and success rate of nerve blocks in ED patients.

The study design will have two comparative arms; in both arms we use the same local anesthetic which is Bupivacaine 0.25% with epinephrine; in all cases a total of 15 mL will be injected around the femoral nerve. Once identified with ultrasound, 5 ml will be injected at lateral, medial, and posterior aspect of the nerve. The experimental arm will receive an FNB using an echogenic needle; and the control group will receive an FNB using standard of care needles.

Conditions

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Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Echogenic needle

The experimental arm will receive ultrasound-guided femoral nerve block using echogenic needles, which are micro laser etched near the tip to reflect sound waves back to the transducer and make the tip visible.

Group Type EXPERIMENTAL

Femoral Nerve Block

Intervention Type DRUG

Femoral Nerve Block for isolated femur fractures

Echogenic needle

Intervention Type DEVICE

The experimental arm will receive ultrasound-guided femoral nerve block using echogenic needles, which are micro laser etched near the tip to reflect sound waves back to the transducer and make the tip visible.

Ultrasound

Intervention Type DEVICE

The experimental arm will receive ultrasound-guided femoral nerve block using echogenic needles, which are micro laser etched near the tip to reflect sound waves back to the transducer and make the tip visible.

The control group will receive ultrasound-guided femoral nerve block using standard of care needles.

Standard of care needle

The control group will receive ultrasound-guided femoral nerve block using standard of care needles.

Group Type ACTIVE_COMPARATOR

Femoral Nerve Block

Intervention Type DRUG

Femoral Nerve Block for isolated femur fractures

Standard of care needle

Intervention Type DEVICE

The control group will receive ultrasound-guided femoral nerve block using standard of care needles.

Ultrasound

Intervention Type DEVICE

The experimental arm will receive ultrasound-guided femoral nerve block using echogenic needles, which are micro laser etched near the tip to reflect sound waves back to the transducer and make the tip visible.

The control group will receive ultrasound-guided femoral nerve block using standard of care needles.

Interventions

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Femoral Nerve Block

Femoral Nerve Block for isolated femur fractures

Intervention Type DRUG

Echogenic needle

The experimental arm will receive ultrasound-guided femoral nerve block using echogenic needles, which are micro laser etched near the tip to reflect sound waves back to the transducer and make the tip visible.

Intervention Type DEVICE

Standard of care needle

The control group will receive ultrasound-guided femoral nerve block using standard of care needles.

Intervention Type DEVICE

Ultrasound

The experimental arm will receive ultrasound-guided femoral nerve block using echogenic needles, which are micro laser etched near the tip to reflect sound waves back to the transducer and make the tip visible.

The control group will receive ultrasound-guided femoral nerve block using standard of care needles.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients who present to the emergency department (ED) with isolated femur fracture (no other injuries)
* Patients who are cognitively alert and are able to verbalize their pain using a visual analog scale (VAS)
* Patients who are mentally competent to consent for the study
* Patients who can communicate in English or Spanish

Exclusion Criteria

* Gestation
* Prisoners
* Patients who cannot communicate in English or in Spanish
* Patients who have other significant injuries besides a femur fracture
* Patients who are cognitively impaired and/or unable to verbalize their pain using a visual analog scale (VAS)
* Patients with allergies to local anesthetics
* Patients with severe liver disease
* Patients with existing peripheral neuropathies in the affected limb
* Patients with history of complications from previous femoral blocks
* Patients with contraindications for needle insertion at inguinal area
* Local signs of infection
* Patient on anticoagulants and/or with history of coagulation disorders
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The University of Texas Health Science Center, Houston

OTHER

Sponsor Role lead

Responsible Party

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Carlos Roldan

Associate Professor - Emergency Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Carlos J Roldan, MD

Role: PRINCIPAL_INVESTIGATOR

The University of Texas Health Science Center, Houston

Locations

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Lyndon Baines Johnson General Hospital

Houston, Texas, United States

Site Status

Memorial Hermann Hospital Texas Medical Center

Houston, Texas, United States

Site Status

Countries

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United States

References

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Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010 Jan;28(1):76-81. doi: 10.1016/j.ajem.2008.09.015.

Reference Type BACKGROUND
PMID: 20006206 (View on PubMed)

Bijur P, Berard A, Nestor J, Calderon Y, Davitt M, Gallagher EJ. No racial or ethnic disparity in treatment of long-bone fractures. Am J Emerg Med. 2008 Mar;26(3):270-4. doi: 10.1016/j.ajem.2007.05.010.

Reference Type BACKGROUND
PMID: 18358935 (View on PubMed)

Brull R, Perlas A, Chan VW. Ultrasound-guided peripheral nerve blockade. Curr Pain Headache Rep. 2007 Feb;11(1):25-32. doi: 10.1007/s11916-007-0018-6.

Reference Type BACKGROUND
PMID: 17214918 (View on PubMed)

Deam RK, Kluger R, Barrington MJ, McCutcheon CA. Investigation of a new echogenic needle for use with ultrasound peripheral nerve blocks. Anaesth Intensive Care. 2007 Aug;35(4):582-6. doi: 10.1177/0310057X0703500419.

Reference Type BACKGROUND
PMID: 18020079 (View on PubMed)

Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003 Feb;41(2):227-33. doi: 10.1067/mem.2003.51.

Reference Type BACKGROUND
PMID: 12548273 (View on PubMed)

Haddad FS, Williams RL. Femoral nerve block in extracapsular femoral neck fractures. J Bone Joint Surg Br. 1995 Nov;77(6):922-3.

Reference Type BACKGROUND
PMID: 7593107 (View on PubMed)

Iamaroon A, Raksakietisak M, Halilamien P, Hongsawad J, Boonsararuxsapong K. Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur. Local Reg Anesth. 2010;3:21-6. doi: 10.2147/lra.s8600. Epub 2010 Mar 25.

Reference Type BACKGROUND
PMID: 22915864 (View on PubMed)

Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003 Oct;10(10):1128-30. doi: 10.1111/j.1553-2712.2003.tb00586.x.

Reference Type BACKGROUND
PMID: 14525749 (View on PubMed)

Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg. 2007 May;104(5):1265-9, tables of contents. doi: 10.1213/01.ane.0000260614.32794.7b.

Reference Type BACKGROUND
PMID: 17456684 (View on PubMed)

Marhofer P, Schrogendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998 Nov-Dec;23(6):584-8. doi: 10.1016/s1098-7339(98)90086-4.

Reference Type BACKGROUND
PMID: 9840855 (View on PubMed)

Marhofer P, Schrogendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg. 1997 Oct;85(4):854-7. doi: 10.1097/00000539-199710000-00026.

Reference Type BACKGROUND
PMID: 9322469 (View on PubMed)

Moher D, Dulberg CS, Wells GA. Statistical power, sample size, and their reporting in randomized controlled trials. JAMA. 1994 Jul 13;272(2):122-4.

Reference Type BACKGROUND
PMID: 8015121 (View on PubMed)

Mutty CE, Jensen EJ, Manka MA Jr, Anders MJ, Bone LB. Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department. Surgical technique. J Bone Joint Surg Am. 2008 Oct;90 Suppl 2 Pt 2:218-26. doi: 10.2106/JBJS.H.00314.

Reference Type BACKGROUND
PMID: 18829935 (View on PubMed)

Saygi B, Ozkan K, Eceviz E, Tetik C, Sen C. Skin traction and placebo effect in the preoperative pain control of patients with collum and intertrochanteric femur fractures. Bull NYU Hosp Jt Dis. 2010;68(1):15-7.

Reference Type BACKGROUND
PMID: 20345356 (View on PubMed)

Terrell KM, Hui SL, Castelluccio P, Kroenke K, McGrath RB, Miller DK. Analgesic prescribing for patients who are discharged from an emergency department. Pain Med. 2010 Jul;11(7):1072-7. doi: 10.1111/j.1526-4637.2010.00884.x.

Reference Type BACKGROUND
PMID: 20642733 (View on PubMed)

Tondare AS, Nadkarni AV. Femoral nerve block for fractured shaft of femur. Can Anaesth Soc J. 1982 May;29(3):270-1. doi: 10.1007/BF03007129.

Reference Type BACKGROUND
PMID: 7074406 (View on PubMed)

Other Identifiers

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HSC-MS-11-0035

Identifier Type: -

Identifier Source: org_study_id