Clinical Outcomes of Analgesia Methods in Patients With Hip Fracture
Condition: Hip Fractures
MeSH terms: Fractures, Bone; Hip Fractures
Study type: Observational

Summary: 
      The goal of this study is to determine of clinical outcomes of analgesia methods. The primary
      outcomes are opioid consumption, static and dynamic visual analog scale (VAS) scores.
      Secondary outcomes are occurrence of side effects.
    

Detailed description: 
      Hip fracture is one of the most serious consequences of falls in the elderly, with a
      mortality of 10% at one month and 30% at one year. Factors of associated with increased
      morbidity and mortality have been researched to prevent complications.

      Pain has been associated with delirium and depression in hip fracture patients. Besides,
      narcotic drugs are also associated with some side effects such as delirium, postoperative
      nausea and vomiting (PONV ), cardiovascular and respiratory depression. These clinical
      problems are especially important in the elderly population.

      Fascia iliaca compartment block (FICB) is one of the methods applied for postoperative
      analgesia, which is applied under the inguinal ligament and distributes between the femoral
      nerve and lateral femoral cutaneous nerve block by volumetric effect. Recently, studies have
      been published on hip fracture patients using pop up technique in emergency services.
      Although many studies have shown that FICB is effective in perioperative analgesia, the
      effects of this method on complications and mortality rate have not yet been investigated.

      The primary objective is to compare morphine consumption and VAS scores in patients with hip
      fracture who treated with epidural catheter, fascia iliaca compartment catheter or patient
      controlled analgesia.

      The secondary objective is to determine complications. The investigators hypothesize that
      FICB catheter will provide good pain control same as epidural catheter, and will decrease
      complications such as delirium and pain with less mortality rate.

      Patients with pain in the hip fracture, will be evaluated after admission to the hospital and
      analgesic treatment will be applied to patients with Visual Analog Pain Scale (VAS) score 3
      and above.

      Patients will be divided into three groups; Group I will include patients with treated FICB
      catheter, Group II will include patients with treated patient controlled analgesia, Group III
      will include patients with treated epidural catheter,

      Catheters will be placed with US visualization in Group I. A hyperechoic needle will be used
      (18 G 80 mm) for inserting catheter in Group I and III.

      Group I will receive 30 ml of Bupivacaine 0.25% solution through the fascia iliaca
      compartment catheter.

      Group II will receive, morphine 0.1 mg/ml via patient controlled analgesia pump. every pump
      will be set 1 mg dose morphine per use and 15 min lockout time.

      Group III will receive 10 ml of Bupivacaine 0.25% solution through the epidural catheter.
    

Intervention name(s): Fascia iliaca compartment catheter; epidural catheter; patient controlled analgesia
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Patient will evaluate and if VAS score >3, catheter will be inserted and 30 ml bupivacaine 0.25% will be applied after admission. Dose will be repeated VAS>3 or patient enounce pain.; Patient will evaluate and if VAS score >3, catheter will be inserted and 10 ml bupivacaine 0.25% will be applied after admission. Dose will be repeated VAS>3 or patient enounce pain.; Patient will evaluate and if VAS score >3, patient controlled analgesia pump will be set 1mg morphine/15 min lockout.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Study will be performed from 01/12/2018 to 01/06/2019. It is estimated to each group
        includes 40 patient.
      
Keywords: hip fracture; fascia iliaca compartment catheter; epidural catheter; delirium; postoperative complications