Blind Fascia Iliaca Compartment Block Compared to Ultrasound-guided Femoral Nerve Block in Patients With Hip Fractures

Study Overview
=================
Brief Summary
-----------------
The goal of this study is to compare the analgesic effect of a blind fascia iliaca compartment block to an ultrasound-guided femoral nerve block in patients that present to the emergency department with hip fractures.

Detailed Description
-----------------
Hip fractures often present to the emergency department and elderly, already fragile, patients are overrepresented. The pain associated with a hip fracture can be severe and have deleterious effects on the patient. Many studies, and a Cochrane review, have shown that a peripheral nerve block provides good pain relief and has many benefits compared to traditional pain relief, such as intravenous morphine. There is less consensus regarding which kind of nerve block, and which technique, is best to use. Many studies compared different kinds of nerve blocks to traditional methods, or more recently compared different kinds of ultrasound-guided techniques to each other. This study proposes to compare the widely used technique of a blind fascia iliaca compartment block (FICB) to an ultrasound-guided femoral nerve block (FNB) that is currently being rolled out locally as an alternative. During the implementation period of this new clinical routine, it will be possible to compare the efficacy of FICB and FNB in reducing participant-reported pain.

Official Title
-----------------
Analgesic Effect of Blind Fascia Iliaca Compartment Block Compared to an Ultrasound-guided Femoral Nerve Block in Patients With Hip Fractures

Conditions
-----------------
Hip Fractures

Intervention / Treatment
-----------------
* Procedure: Fascia Iliaca Compartment Block
* Procedure: Femoral Nerve Block
* Drug: Ropivacaine


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adult emergency department patient over 18 years of age with a radiologically verified fracture classified as hip fracture that are eligible for a peripheral nerve block according to local guidelines Exclusion Criteria: Multi-system trauma Isolated pelvic or diaphyseal femur fracture Patients unable to communicate regardless of reason Patients with contraindications to receiving a peripheral nerve block with an amide local anaesthetic according to local guidelines

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Fascia Iliaca Compartment Block (FICB)<br>Participants with a radiologically verified hip fracture receiving a FICB using a blind technique guided by anatomical landmarks. | Procedure: Fascia Iliaca Compartment Block<br>* Blind technique.<br>* Other names: Regional anesthesia;Drug: Ropivacaine<br>* Ropivacaine dosed according to local guidelines.<br>* Other names: Naropin;|
| Femoral Nerve Block (FNB)<br>Participants with a radiologically verified hip fracture receiving a FNB using ultrasound guidance for direct nerve visualisation. | Procedure: Femoral Nerve Block<br>* Ultrasound guided.<br>* Other names: Regional anesthesia;Drug: Ropivacaine<br>* Ropivacaine dosed according to local guidelines.<br>* Other names: Naropin;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Change from Baseline in Pain Scores on the Numeric Rating Scale (0 to 10, where 10 is Maximum Pain) at 30 minutes after Administration of Block, at Rest and During Active Hip Flexion | Change in reported pain score should be at least one whole unit on the numeric rating scale. | Measured 30 minutes after administered nerve block. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ratio of Failed Blocks | Defined by a failure to reduce reported pain 30 minutes after administered block by at least one whole unit on the numeric rating scale | Through study completion, an average of 1 year | 
| Rate of Complications | Comparing the rate of any reported complication between cohorts | Through study completion, an average of 1 year |