Ultrasound-guided Femoral Nerve Blocks in Elderly Patients With Hip Fractures
Condition: Femoral Neck Fractures; Hip Fractures
MeSH terms: Fractures, Bone; Hip Fractures; Femoral Neck Fractures
Intervention: Femoral nerve block: 25 mL of 0.5% bupivacaine; Placebo: 3cc of 0.9% Normal Saline
Intervention description: 25ml of 0.5% bupivacaine will be injected along the nerve sheath. The nerve block will be administered by one of the physician co- investigators all of whom are emergency physicians and all of whom have been trained in the use of ultrasound and ultrasound guided nerve blocks.; 1cm lateral to the ultrasound probe, a 27 gauge needle and syringe will be used to inject 3cc of 0.9% NS subcutaneously. The SC group will then be cared for by the Emergency Department physicians according to their regular clinical practice
Intervention MeSH terms: Bupivacaine
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Enrollment: 38.0
Sex: All
Minimum age: 55 Years
Healthy volunteers: No
Keywords: Femur; Hip; Fracture; Femoral neck; Femoral head

Summary:

      The purpose of this study is to determine if ultrasound guided femoral nerve blocks
      (localized anesthesia in the upper thigh) provide effective pain relief in adult patients
      with hip fractures in the emergency department and to determine if femoral nerve blocks can
      then be used to reduce the use of injected analgesia (anesthesia), therefore also causing
      fewer adverse effects associated with injected analgesia (such as bruising at the site of
      injection).

      100 patients with hip fractures will be enrolled in the study. Patients will be randomly
      assigned to receive a femoral nerve block (FNB) plus injected analgesia or standard care
      (SC), which is injected analgesia alone.

      Using guidance from an ultrasound machine, the FNB group will have 20ml of 0.5% bupivacaine
      (a local anesthetic of long duration) injected into the front of the thigh, at the site of
      pain. Patients randomized to the SC group will receive an injection of saline (saltwater) so
      that no neither the patient or the treating physician knows to which group the patient was
      randomized. All blocks will be performed in the emergency department by an emergency
      physician trained in the use of ultrasound and ultrasound guided nerve blocks.

      Subjects will be asked to rate their pain on a numeric pain scale both before and after
      intervention (30 min, 60 min, 12 hrs and 24 hrs after injection, as long as the patient is in
      the ER still). Additional data to be collected includes demographics, vital signs, and course
      of treatment resulting from the ED visit.

      Hypothesis: US-guided femoral nerve blocks can provide effective pain control and possibly
      decrease or eliminate the need for narcotics.
    

Eligibility criteria:

        Inclusion Criteria:

          -  English speaking

          -  Adults over age 55

          -  Able to understand and give informed consent

          -  Comfortable with the experimental protocol as outlined to them by the RA or physician
             investigator

          -  Have radiologically confirmed hip fractures: femoral head, femoral neck
             intertrochanteric, or subtrochanteric femur fractures

        Exclusion Criteria:

          -  Femoral artery grafts on the same side as the fracture

          -  Extensive lower extremity trauma

          -  Concurrent tibia-fibula fractures

          -  Hypersensitivity to local anesthetics or morphine

          -  Neurovascular injury