Combined Lumbosacral Nerve Block Versus Spinal Anesthesia for Cognitive Function After Hip Prothesis

NCT ID: NCT03794427

Last Updated: 2022-01-18

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-02

Study Completion Date

2022-04-30

Brief Summary

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Hip fracture is a potentially devastating event, and serious surgical and medical complications occur frequently especially for elderly patients. Delirium is one of the common complications after hip surgery. Controversy exists regarding the possible impact of type of anesthesia (nerve block versus spinal) upon acute and long-term cognitive decline.

The primary objective is to assess the association between type of anesthesia (nerve block vs. spinal anesthesia) and risk of cognitive decline (CD). The secondary objective is to compare intra-operative hemodynamic changes, use of vasopressor drugs, and use of post-operative analgesics with respect to the type of anesthesia.

Prospective, double blind randomized clinical trial of hip fracture patients who will be assessed for CD pre- and postoperatively, using the Mini Mental State Examination (MMSE). The presence of CD will be determined at follow-up evaluation up to three months after surgery.

Detailed Description

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Prospective, double blind randomized clinical trial of hip fracture patients who will be assessed for CD pre- and postoperatively, using the Mini Mental State Examination (MMSE). The presence of CD will be determined at follow-up evaluation up to three months after surgery. Patients undergoing hip surgery will be randomized into two groups. Group 1 will receive unilateral lumbosacral nerve block (sciatic nerve block and paravertebral block at levels L3-L4 and L4-L5) as well as placebo injection (1 ml normal saline) at the spinal anesthesia level (L3-L4 or L4-L5). The sciatic nerve will be injected by 20 ml of the anesthetic mixture whereas levels L3-L4 and L4-L5 will be injected by a total of 20 ml of the anesthetic mixture without exceeding the maximum injected volume of 1 ml/kg. Group 2 will receive spinal anesthesia (3 ml of 0.5% bupivacaine) in addition to placebo injection at the sciatic, L3-L4 and L4-L5 levels.

Conditions

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Cognitive Decline

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Investigators

Study Groups

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unilateral lumbosacral nerve block

Sciatic nerve block and paravertebral block at levels L3-L4 and L4-L5 will be performed

Group Type EXPERIMENTAL

unilateral lumbosacral nerve block

Intervention Type OTHER

Patients will receive unilateral lumbosacral nerve block (sciatic nerve block and paravertebral block at levels L3-L4 and L4-L5). The sciatic nerve will be injected by 20 ml of the anesthetic mixture whereas levels L3-L4 and L4-L5 will be injected by a total of 20 ml of the anesthetic mixture without exceeding the maximum injected volume of 1 ml/kg.

Placebo at the spinal anesthesia level

Intervention Type OTHER

Patients will receive 1 ml normal saline at the spinal anesthesia level (L3-L4 or L4-L5).

Spinal anesthesia

spinal anesthesia will be performed

Group Type ACTIVE_COMPARATOR

Spinal anesthesia

Intervention Type OTHER

Patients will receive spinal anesthesia (3 ml of 0.5% bupivacaine)

Placebo at lumbosacral level

Intervention Type OTHER

Patients will receive normal saline at the sciatic, L3-L4 and L4-L5 levels

Interventions

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unilateral lumbosacral nerve block

Patients will receive unilateral lumbosacral nerve block (sciatic nerve block and paravertebral block at levels L3-L4 and L4-L5). The sciatic nerve will be injected by 20 ml of the anesthetic mixture whereas levels L3-L4 and L4-L5 will be injected by a total of 20 ml of the anesthetic mixture without exceeding the maximum injected volume of 1 ml/kg.

Intervention Type OTHER

Spinal anesthesia

Patients will receive spinal anesthesia (3 ml of 0.5% bupivacaine)

Intervention Type OTHER

Placebo at the spinal anesthesia level

Patients will receive 1 ml normal saline at the spinal anesthesia level (L3-L4 or L4-L5).

Intervention Type OTHER

Placebo at lumbosacral level

Patients will receive normal saline at the sciatic, L3-L4 and L4-L5 levels

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Admitted with a hip fracture (femoral neck, trochanteric or sub-trochanteric)
* 40 kg in weight and higher

Exclusion Criteria

Patients who are:

* Uncooperative
* Considered as moribund by the orthopedic surgeon at admission
* Alzheimer
* Severe cognitive impairment (MMSE\<18)
* Absolute contraindication for spinal anesthesia (assessed preoperatively)
* Allergy to local anesthesia
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Makassed General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Zoher Naja

Anesthesiologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Zoher Naja

Role: PRINCIPAL_INVESTIGATOR

Makassed General Hospital

Locations

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Makassed General Hospital

Beirut, , Lebanon

Site Status RECRUITING

Countries

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Lebanon

Central Contacts

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Zoher Naja

Role: CONTACT

+9611636000 ext. 6405

Facility Contacts

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Zoher Naja, MD

Role: primary

+9611636000 ext. 6941

Other Identifiers

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181218

Identifier Type: -

Identifier Source: org_study_id

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