Nurse Led Ultrasound Guided Femoral Nerve Block in the Emergency Department
Condition: Hip Fractures; Anesthesia; Femoral Neck Fractures
MeSH terms: Emergencies; Fractures, Bone; Hip Fractures; Femoral Neck Fractures
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effects of task shifting from anesthesiologists
      to special trained nurses performing femoral nerve block (FNB) in patients with hip fracture
      in the emergency department (ED) at Vestfold Hospital Trust (VHT). A sample of nurses (n= 6)
      will perform ultrasound guided FNB in hip fracture patients (n=25) admitted to the ED at VHT.
      This cohort will be compared to another cohort of hip fracture patients (n=25). This cohort
      will follow standard of care where the femoral nerve block is often performed by
      anesthesiologists. The study is a prospective, controlled randomized trial.
    

Detailed description: 
      The ageing population admitted to the ED in developed countries is steadily increasing. Hip
      fractures are common among the elderly population, and related to increased mortality.
      Patient satisfaction with ED's has been an international challenge over several years. Acute
      pain is one of the most common reasons for patients coming admitted to the ED. However,
      undertreatment of pain is common, particularly in patients with hip fractures.

      Pain control can be difficult, and often requires intensive nursing and physician care, as
      elderly patients may manifest cardiovascular and respiratory complications from opioid
      administration. Optimizing acute pain management in patients with orthopedic trauma is
      important and can translate into significant positive physiologic and financial outcomes.

      At Vestfold Hospital Trust, pain relief of the hip fracture patient in ED has traditionally
      most often consisted of paracetamol and opiates. Additionally, the patients are offered FNB
      by the anesthesiologist, but concurrent conflicts and other organizational circumstances has
      have led to delayed block or no block for all or some patients. This often necessitate a
      continuation of pain relief in form of intravenous opioids, with increased risk of opioid
      side effects such as respiratory depression, delirium, constipation, urinary retention,
      nausea and vomiting and subsequently increased morbidity and increased costs for the hospital
      and the community.

      The investigators believe that shifting this task to nurses working in the ED can secure
      patient with hip fractures sufficiently and timely pain relief. By giving trained nurses this
      new task of performing FNB the investigators can study how expert nurses qualifications' are
      utilized to strengthen the quality of the ED. This study aims to implement and evaluate the
      introduction of specially trained nurses performing ultrasound guided FNB in patients with
      hip fractures in the ED. This implementation may be beneficial to patients in terms of prompt
      analgesia, reduced opioid consumption, thereby reducing opioid adverse events, and it might
      influence risk of complications and length of stay. The aim of this study is to evaluate
      cumulative Numeric Rating Scale (NRS) score during rest and during passive movement (30
      degree flexion in the hip) in patients with hip fracture during stay in the ED at 120 minutes
      after admission, thereby comparing nurse-led FNB versus standard of care.

      The study has a randomized controlled trial design. Patients are randomized (1:1) into two
      groups:

        1. Trained nurses in ED provide ultrasound guided single-shot FNB shortly after (at arrival
           ED) the patient is diagnosed with a hip fracture.

        2. Nurses do not provide ultrasound guided single-shot FNB and the patient follows the
           FAST-TRACK-HIP FRACTURE course local guideline at our hospital.

      Hypothesis: A single shot FNB performed by nurses in the ED compared to todays practice will
      result in lower cumulative NRS score first 120 minutes after admission to ED than current
      practice.
    

Intervention name(s): Nurse-led femoral nerve block
Intervention type(s): Procedure
Intervention description(s): The nurse perform a femoral nerve block in the emergency department in patients diagnosed with a hip fracture (x-ray)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective, randomized, controlled, open label trial
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: femoral nerve block; Ultrasound guided; Nurse-led