Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: ED Ultrasonographic Regional Anesthesia to Prevent Incident Delirium in Hip Fracture Patients (EDU-RAPID) Multi-center Stepped Wedge Cluster Randomized Trial
Brief Summary: Hip fractures are common, costly and affect older people - Canadians spend 1 billion dollars to treat hip fractures each year. Unfortunately, as many as two-thirds of hip fracture cases suffer a complication known as delirium, or acute confusion. Patients with delirium may become frightened and agitated. This in turn leads to other serious problems. Having delirium doubles the chances of dying or can increase the need for admission into a nursing home. People with delirium spend an extra week in hospital on average.

Using ultrasound to locate and 'freeze' or block specific nerves can stop hip fracture pain almost immediately, and use of this technique is known to reduce delirium when administered by Anaesthetists to patients at the time of their hip operation. Unfortunately, patients with hip fractures commonly wait hours or even days in the Emergency Department (ED) prior to their operation. Currently, these patients are given narcotic pain killers like morphine to dull their pain, as most ED physicians have not been trained in using this 'freezing' technique and Anaesthetists are rarely able to leave the operating room to administer freezing to patient in the ED.

The EDU-RAPID study will test whether training ED physicians on how to use the nerve freezing technique will reduce the number of patients who develop delirium after a hip fracture. To study this, ED physicians will be trained at 6 hospitals in small groups every 6 weeks over 18 months. The study will look at how patients who are treated by ED physician who has been trained compare to patients treated by a ED physician who has not yet been trained. Also, the study will see if the training motivates ED physicians to use the block regularly.

If correct, this study could significantly improve the comfort, quality of life, and independence of patients who suffer a hip fracture. In addition, if the study shows a reduction in delirium rates, this could represent a significant cost reduction to the health care system.


Options:
A: Arm Label: Ropivacaine; Type: ACTIVE_COMPARATOR; Interventions: Drug: Ropivacaine | Arm Label: Saline; Type: PLACEBO_COMPARATOR; Interventions: Drug: Ropivacaine | Intervention Type: DRUG; Name: Ropivacaine; Assigned to Arm(s): Ropivacaine, Saline
B: Arm Label: U/S Guided Regional Anesthesia; Type: EXPERIMENTAL; Interventions: Procedure: Fascia-Iliaca Block(FIB), Procedure: Femoral Nerve Block(FNB) | Arm Label: Current Local Standard Analgesia; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: PROCEDURE; Name: Fascia-Iliaca Block(FIB); Assigned to Arm(s): U/S Guided Regional Anesthesia | Intervention Type: PROCEDURE; Name: Femoral Nerve Block(FNB); Assigned to Arm(s): U/S Guided Regional Anesthesia
C: Arm Label: ropivacaine; Type: ACTIVE_COMPARATOR; Interventions: Drug: Ropivacaine | Arm Label: Natrium chloride; Type: PLACEBO_COMPARATOR; Interventions: Drug: Natrium chloride | Intervention Type: DRUG; Name: Ropivacaine; Assigned to Arm(s): ropivacaine | Intervention Type: DRUG; Name: Natrium chloride; Assigned to Arm(s): Natrium chloride
D: Arm Label: fascia iliaca compartment block; Type: ACTIVE_COMPARATOR; Interventions: Drug: Ropivacaine, Device: Ultrasound | Arm Label: intravenous fentanyl; Type: ACTIVE_COMPARATOR; Interventions: Drug: Fentanyl | Intervention Type: DRUG; Name: Ropivacaine; Assigned to Arm(s): fascia iliaca compartment block | Intervention Type: DRUG; Name: Fentanyl; Assigned to Arm(s): intravenous fentanyl | Intervention Type: DEVICE; Name: Ultrasound; Assigned to Arm(s): fascia iliaca compartment block

Answer: B