Please select the eligibility criteria that correspond to the clinical trial below.
Title: Continuous Fascia Iliaca Block for Acute Hip Fractures: a Randomized Controlled Pilot Study
Brief Summary: Hip fractures are a major cause of morbidity and mortality in the elderly with over 30,000 hip fractures occuring in Canada annually and over 1300 in Saskatchewan. The estimated cost associated with hip fractures is over $600 million nationally and 28 million dollars in Saskatchewan. Hip fractures cause a great deal of pain and immobility and are mainly treated with surgical fixation. In the perioperative period, hip fracture patients are treated mainly with opioids and other adjuncts such as NSAIDS and acetaminophen. Opioid consumption in the elderly population can predispose to delirium and respiratory complications such as atelectasis, respiratory depression, and pneumonia.

Fascia iliaca blocks have been shown to be an effective mode of analgesia for patients with hip fractures, but are underutilized for varying reasons including culture of practice, expertise with performing the block, and having a dedicated service to do so.

This study aims to compare the efficacy of fascia iliaca blocks to standard treatment (opioids) in the management of pain in hip fracture patients with a particular focus on outcomes such as the incidence of delirium, respiratory complications, and length of stay in hospital. Our idea is that if we can reduce the amount of opioids these patients receive then they will have improved pain control, fewer respiratory complications, earlier time to mobilizing, and shorter hospital stays. As far as we are aware this relation has not been well studied.


Options:
A: Inclusion Criteria:

* Female ASA physical status 1-3 scheduled for total hip arthroplasty
* Age 18-80 years old
* Able to participate personally or by legal representative in informed consent in English or Spanish

Exclusion Criteria:

* History of relevant drug allergy
* Age less than 18 or greater than 80 years
* Chronic opioid use or drug abuse
* Significant psychiatric disturbance
* Inability to understand the study protocol
* Refusal to provide written consent
B: Inclusion Criteria:

* American Society of Anesthesiologist physical status I to III
* Patients scheduled for fixation for proximal end femur fracture

Exclusion Criteria:

* Patients refusal
* Morbid obese patients (BMI\>40)
* Bleeding diathesis
* Previous femoral bypass surgery
* Inguinal hernia
* Inflammation/infection over injection site
* Peripheral neuropathy
* Allergy to local anesthetics agents used.
* Severely altered consciousness level
* Psychiatric disorders
* Polytrauma
C: Inclusion Criteria:

* At the cluster level, ED physicians practicing at a participating site will be eligible.
* At the patient level, all hip fractures seen by a participating ED physician will be eligible

Exclusion Criteria:

* ED physicians who work casually (less than 0.25 Full Time Equivalent)
* ED Physicians who are routinely using U/S guided RA for hip fracture patients, or decline participation in the trial.
* Patients' age less than 65 years;
* Patients who are delirious on initial assessment by ED physician or severe dementia
* Patients with communication problems (critically ill, unconscious, language barrier despite use of secure telephone-based translation service)
* Patients with allergies to narcotics or local anesthetic; or anticoagulant use (e.g. warfarin, dabigatran, rivaroxaban).
* Patients with hip fractures not requiring surgery (e.g. greater trochanter avulsion) will also be excluded.
D: Inclusion Criteria:

* Adults age greater than or equal to 65 years old with acute hip fracture

Exclusion Criteria:

* ASA greater than or equal to 4
* Open fractures
* Other concomitant injuries that may interfere with positioning or pain scores
* Local anesthetic allergy
* Delirium at the time of consent
* Pre-existing cognitive impairment
* Infection at the site of injection for cFIB
* Previous surgery in femoral triangle
* Warfarin or Anti-Xa inhibitor use
* Long-term opioid use
* Intraoperative complications

Answer: D