Surgical Treatment of Hip Fractures Under Peripheral Regional Anesthesia

NCT ID: NCT04005404

Last Updated: 2021-02-18

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

COMPLETED

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-08-05

Study Completion Date

2020-06-30

Brief Summary

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The study investigates whether treatment of proximal femoral fractures is possible using a peripheral regional anesthesia technique.

Detailed Description

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The study investigates whether treatment of proximal femoral fractures is possible using a peripheral regional anesthesia technique.

After positioning on the non-fractured side, a double injection technique is used (dual guidance concept: nerve stimulation and sonography).

The injections are performed parasacrally (blockade of the sacral plexus under the piriformis muscle) and lumbar paravertebrally (psoas compartment block and transmuscular quadratus lumborum block). Per block 20 ml ropivacaine 0.375% is administered (total dose: 225mg ropivacaine).

The study examines the success rate (rate of successfully performed nerve blockade; need for supplemental medication: sufentanil and/or propofol; conversion rate to general anesthesia), circulatory stability (need for application of ephedrine or norepinephrine) and side effects.

Conditions

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Hip Fractures

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Differentiated analysis for the subgroups "subtrochanteric femoral fractures", "intertrochanteric femoral fractures" and "neck femur fractures"
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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intertrochanteric femoral fractures

geriatric patients with intertrochanteric femoral fracture who have consented to the study intervention

Group Type EXPERIMENTAL

Ropivacaine (sciatic nerve block)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

Ropivacaine (lumbar plexus block L2-L4)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

Ropivacaine (lumbar plexus block Th12-L1)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

neck femur fractures

geriatric patients with neck of femur fracture who have consented to the study intervention

Group Type EXPERIMENTAL

Ropivacaine (sciatic nerve block)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

Ropivacaine (lumbar plexus block L2-L4)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

Ropivacaine (lumbar plexus block Th12-L1)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

subtrochanteric femoral fractures

geriatric patients with subtrochanteric femoral fracture who have consented to the study intervention

Group Type EXPERIMENTAL

Ropivacaine (sciatic nerve block)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

Ropivacaine (lumbar plexus block L2-L4)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

Ropivacaine (lumbar plexus block Th12-L1)

Intervention Type DRUG

injection of 20 ml ropivacaine 0.375%

Interventions

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Ropivacaine (sciatic nerve block)

injection of 20 ml ropivacaine 0.375%

Intervention Type DRUG

Ropivacaine (lumbar plexus block L2-L4)

injection of 20 ml ropivacaine 0.375%

Intervention Type DRUG

Ropivacaine (lumbar plexus block Th12-L1)

injection of 20 ml ropivacaine 0.375%

Intervention Type DRUG

Other Intervention Names

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parasacral sciatic nerve block (sacral plexus) posts compartment block (lumbar plexus L2-L4) transmuscular quadratus lumborum block (lumbar plexus Th12-L1)

Eligibility Criteria

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Inclusion Criteria

* proximal femoral fracture
* older then 18 years
* written informed consent

Exclusion Criteria

* local or systematic inflammation
* allergy to ropivacaine
* participate in other studies
* body mass index over 35
* periprosthetic fractures
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Helios Research Center

OTHER

Sponsor Role lead

Responsible Party

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Dr.med.Ronald Seidel

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Helios Medical Center Schwerin, Department of Anesthesiology

Schwerin, Mecklenburg-Vorpommern, Germany

Site Status

Countries

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Germany

References

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Adhikary SD, Short AJ, El-Boghdadly K, Abdelmalak MJ, Chin KJ. Transmuscular quadratus lumborum versus lumbar plexus block for total hip arthroplasty: A retrospective propensity score matched cohort study. J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):372-378. doi: 10.4103/joacp.JOACP_335_17.

Reference Type BACKGROUND
PMID: 30386022 (View on PubMed)

Akkaya T, Comert A, Kendir S, Acar HI, Gumus H, Tekdemir I, Elhan A. Detailed anatomy of accessory obturator nerve blockade. Minerva Anestesiol. 2008 Apr;74(4):119-22.

Reference Type BACKGROUND
PMID: 18354367 (View on PubMed)

Birnbaum K, Prescher A, Hessler S, Heller KD. The sensory innervation of the hip joint--an anatomical study. Surg Radiol Anat. 1997;19(6):371-5. doi: 10.1007/BF01628504.

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Coburn M, Sanders RD, Maze M, Nguyen-Pascal ML, Rex S, Garrigues B, Carbonell JA, Garcia-Perez ML, Stevanovic A, Kienbaum P, Neukirchen M, Schaefer MS, Borghi B, van Oven H, Tognu A, Al Tmimi L, Eyrolle L, Langeron O, Capdevila X, Arnold GM, Schaller M, Rossaint R; HIPELD Study Investigators. The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the prevention of postoperative delirium: a multicentre, randomized clinical trial. Br J Anaesth. 2018 Jan;120(1):127-137. doi: 10.1016/j.bja.2017.11.015. Epub 2017 Nov 21.

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Reference Type BACKGROUND
PMID: 30032877 (View on PubMed)

Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.

Reference Type BACKGROUND
PMID: 30063657 (View on PubMed)

Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016 Feb 22;2(2):CD000521. doi: 10.1002/14651858.CD000521.pub3.

Reference Type BACKGROUND
PMID: 26899415 (View on PubMed)

Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral Nerve Blocks for Hip Fractures: A Cochrane Review. Anesth Analg. 2018 May;126(5):1695-1704. doi: 10.1213/ANE.0000000000002489.

Reference Type BACKGROUND
PMID: 28991122 (View on PubMed)

Johnston DF, Stafford M, McKinney M, Deyermond R, Dane K. Peripheral nerve blocks with sedation using propofol and alfentanil target-controlled infusion for hip fracture surgery: a review of 6 years in use. J Clin Anesth. 2016 Mar;29:33-9. doi: 10.1016/j.jclinane.2015.10.012. Epub 2016 Feb 2.

Reference Type BACKGROUND
PMID: 26897445 (View on PubMed)

Nielsen TD, Moriggl B, Soballe K, Kolsen-Petersen JA, Borglum J, Bendtsen TF. A Cadaveric Study of Ultrasound-Guided Subpectineal Injectate Spread Around the Obturator Nerve and Its Hip Articular Branches. Reg Anesth Pain Med. 2017 May/Jun;42(3):357-361. doi: 10.1097/AAP.0000000000000587.

Reference Type BACKGROUND
PMID: 28263244 (View on PubMed)

Sa M, Graca R, Reis H, Cardoso JM, Sampaio J, Pinheiro C, Machado D. [Superior gluteal nerve: a new block on the block?]. Braz J Anesthesiol. 2018 Jul-Aug;68(4):400-403. doi: 10.1016/j.bjan.2016.11.001. Epub 2017 May 24.

Reference Type BACKGROUND
PMID: 28551063 (View on PubMed)

Sauter AR, Ullensvang K, Niemi G, Lorentzen HT, Bendtsen TF, Borglum J, Pripp AH, Romundstad L. The Shamrock lumbar plexus block: A dose-finding study. Eur J Anaesthesiol. 2015 Nov;32(11):764-70. doi: 10.1097/EJA.0000000000000265.

Reference Type BACKGROUND
PMID: 26426575 (View on PubMed)

Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018 Feb;43(2):186-192. doi: 10.1097/AAP.0000000000000701.

Reference Type BACKGROUND
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Taha AM. A simple and successful sonographic technique to identify the sciatic nerve in the parasacral area. Can J Anaesth. 2012 Mar;59(3):263-7. doi: 10.1007/s12630-011-9630-3. Epub 2011 Dec 3.

Reference Type BACKGROUND
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Ueshima H, Otake H, Lin JA. Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:2752876. doi: 10.1155/2017/2752876. Epub 2017 Jan 3.

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Van Waesberghe J, Stevanovic A, Rossaint R, Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol. 2017 Jun 28;17(1):87. doi: 10.1186/s12871-017-0380-9.

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White SM, Moppett IK, Griffiths R, Johansen A, Wakeman R, Boulton C, Plant F, Williams A, Pappenheim K, Majeed A, Currie CT, Grocott MP. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia. 2016 May;71(5):506-14. doi: 10.1111/anae.13415. Epub 2016 Mar 4.

Reference Type BACKGROUND
PMID: 26940645 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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A 2018 0237

Identifier Type: -

Identifier Source: org_study_id

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