Ultrasound Guided Femoral Nerve Block

NCT ID: NCT02381717

Last Updated: 2024-04-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-08-31

Study Completion Date

2026-12-31

Brief Summary

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The goal of the study is to evaluate whether pain control achieved by Ultrasound Guided Femoral Nerve Blockade (USFNB) is equal in efficacy to standard pain management practice of parenteral injection of opioid pain medication in patients presenting to the emergency department (ED) with hip fracture.

Detailed Description

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In this proposed protocol the investigators will conduct a prospective, randomized control trial comparing the efficacy of Ultrasound Guided Femoral Nerve Blockade (USFNB) versus the standard of care pain management by parenteral injection of opioid pain medication of patients presenting with hip fracture at the BIDMC ED. We hypothesize that USNFB approach will be non-inferior in achieving pain control (efficacy) and superior in the total dose of opioids (lower amount) as compared to the standard protocol. The enrolled population will be randomized 1:1 using a simple balanced randomization scheme.

Participants will be surveyed six times 6 times on a Visual Analog Scale (VAS)\* on their pain intensity reduction over 4 hours.

Physicians performing the block will be surveyed promptly following the procedure regarding difficulty performing the block and its efficacy.

Specific Aim #1: The investigators hypothesize that in patients presenting to the ED with hip fracture, USFNB will demonstrate equal efficacy in pain relief with fewer side effects when compared to conventional parenteral opioid therapy. The investigators evaluate this hypothesis by monitoring Visual Analogue Scales (VAS) in patients receiving either USGFNB or opioid therapy over the first 4 hours of observation. The side effects will be noted during the same interval of time.

Specific Aim #2: The investigators hypothesize that in patients presenting to the ED with hip fracture, USFNB will reduce the amount of narcotic used to control pain. The investigators will evaluate this by studying narcotic use over the first 4 hours of evaluation.

Conditions

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Hip Fracture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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ultra-sound guided femoral nerve block

Patients in this arm will receive a bed-side ultrasound guided femoral nerve block with analgesia 0.5% bupivacaine (2mg/kg)

Group Type EXPERIMENTAL

ultra-sound guide

Intervention Type OTHER

Patients randomized to this arm will have the femoral nerve block with the guidance of a bedside ultrasound

bupivacaine

Intervention Type DRUG

standard of care- IV morphine

Patients in this arm will have the femoral nerve block block with no ultrasound for guidance with analgesia (IV morphine)

Group Type ACTIVE_COMPARATOR

morphine

Intervention Type DRUG

Interventions

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ultra-sound guide

Patients randomized to this arm will have the femoral nerve block with the guidance of a bedside ultrasound

Intervention Type OTHER

bupivacaine

Intervention Type DRUG

morphine

Intervention Type DRUG

Other Intervention Names

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femoral nerve block femoral nerve block with analgesia 0.5% bupivacaine (2mg/kg) femoral nerve block block with no ultrasound for guidance with analgesia (IV morphine)

Eligibility Criteria

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Inclusion Criteria

* Patients over 18 years of age presenting to the ED with radiographically established intra-, extracapsular hip fracture, able to consent and participate in the study and who have moderate to severe pain (numerical pain score \>= 31) at the time of enrollment.

Exclusion Criteria

* Patients with a previous history of hypersensitivity to local anesthetics,
* Patients who have signs of a local infection at the site of planned needle placement.
* INR \> 1.4NOAC use within 48 hours
* Prophylactic Low-Molecular Weight Heparin (LMWH) within 12 hours
* Therapeutic LMWH within 24 hours
* Prophylactic Unfractionated Heparin (5000 Units BID or TID) within 6 hours
Minimum Eligible Age

18 Years

Maximum Eligible Age

101 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Beth Israel Deaconess Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Beatrice Hoffmann

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Beatrice Hoffmann, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Beth Israel Deaconess Medical

Locations

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Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status RECRUITING

St. Vincent's Hospital

Worcester, Massachusetts, United States

Site Status COMPLETED

Countries

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United States

Central Contacts

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Beatrice Hoffmann, MD PhD

Role: CONTACT

617-754-2323

Elinita Rosseto

Role: CONTACT

617-754-2332

Facility Contacts

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Beatrice Hoffmann, MD PhD

Role: primary

617-754-2323

Hayes Sharon, RN

Role: backup

617-754-2334

References

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Morrison RS, Magaziner J, Gilbert M, Koval KJ, McLaughlin MA, Orosz G, Strauss E, Siu AL. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003 Jan;58(1):76-81. doi: 10.1093/gerona/58.1.m76.

Reference Type BACKGROUND
PMID: 12560416 (View on PubMed)

Christos SC, Chiampas G, Offman R, Rifenburg R. Ultrasound-guided three-in-one nerve block for femur fractures. West J Emerg Med. 2010 Sep;11(4):310-3.

Reference Type BACKGROUND
PMID: 21079698 (View on PubMed)

Baker BC, Buckenmaier C, Narine N, Compeggie ME, Brand GJ, Mongan PD. Battlefield anesthesia: advances in patient care and pain management. Anesthesiol Clin. 2007 Mar;25(1):131-45, x. doi: 10.1016/j.anclin.2006.12.003.

Reference Type BACKGROUND
PMID: 17400161 (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)

Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism. Crit Care Med. 2008 Jul;36(7 Suppl):S346-57. doi: 10.1097/CCM.0b013e31817e2fc9.

Reference Type BACKGROUND
PMID: 18594262 (View on PubMed)

Grabinsky A, Sharar SR. Regional anesthesia for acute traumatic injuries in the emergency room. Expert Rev Neurother. 2009 Nov;9(11):1677-90. doi: 10.1586/ern.09.110.

Reference Type BACKGROUND
PMID: 19903026 (View on PubMed)

O'Donnell BD, Mannion S. Ultrasound-guided femoral nerve block, the safest way to proceed? Reg Anesth Pain Med. 2006 Jul-Aug;31(4):387-8. doi: 10.1016/j.rapm.2006.04.007. No abstract available.

Reference Type BACKGROUND
PMID: 16857561 (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)

Todd KH. Clinical versus statistical significance in the assessment of pain relief. Ann Emerg Med. 1996 Apr;27(4):439-41. doi: 10.1016/s0196-0644(96)70226-3. No abstract available.

Reference Type BACKGROUND
PMID: 8604855 (View on PubMed)

Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001 May;18(3):205-7. doi: 10.1136/emj.18.3.205.

Reference Type BACKGROUND
PMID: 11354213 (View on PubMed)

Platts-Mills TF, Esserman DA, Brown DL, Bortsov AV, Sloane PD, McLean SA. Older US emergency department patients are less likely to receive pain medication than younger patients: results from a national survey. Ann Emerg Med. 2012 Aug;60(2):199-206. doi: 10.1016/j.annemergmed.2011.09.014. Epub 2011 Oct 26.

Reference Type BACKGROUND
PMID: 22032803 (View on PubMed)

Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med. 2005 Oct;46(4):362-7. doi: 10.1016/j.annemergmed.2005.03.010.

Reference Type BACKGROUND
PMID: 16187470 (View on PubMed)

Fredrickson MJ, Kilfoyle DH. Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study. Anaesthesia. 2009 Aug;64(8):836-44. doi: 10.1111/j.1365-2044.2009.05938.x.

Reference Type BACKGROUND
PMID: 19604186 (View on PubMed)

Guay J, Kopp S. Peripheral nerve blocks for hip fractures in adults. Cochrane Database Syst Rev. 2020 Nov 25;11(11):CD001159. doi: 10.1002/14651858.CD001159.pub3.

Reference Type DERIVED
PMID: 33238043 (View on PubMed)

Other Identifiers

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2014P000304

Identifier Type: -

Identifier Source: org_study_id

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