Needle Nerve Contact in Ultrasound Guided Femoral Block

Study Overview
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Brief Summary
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Ultrasound-guided femoral nerve block is a common regional anesthesia technique. The optimal method of needle guidance (in-plane versus out-of-plane) with regards to the block efficacy and avoidance of needle-nerve contact has not been established. In this study the investigators tests the hypothesis that the incidence of needle-nerve contact is higher with the needle insertion in an out-of-plane than with the in-plane approach.

Detailed Description
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Fourty-four patients with hip fracture (American Society of Anesthesiologists physical status 1-3) are being randomized to receive the femoral block with an out-of-plane (needle inserted at a 45°-60° angle 1 cm caudal to the midpoint of the ultrasound probe just above the femoral nerve) or an in-plane technique (needle inserted 0.5 cm from the side of the probe lateral to the femoral nerve). The data collected includes the depth of needle insertion at the endpoint before injection, response to nerve stimulation, distribution of the injected volume in relation to the nerve (anterior vs posterior, the latter indicating impalement), block efficacy at 20 minutes and 24 hours, and any signs of nerve injury).

Official Title
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Incidence of Intraneural Needle Insertion in Ultrasound Guided Femoral Block: Out of Plane Versus in Plane Approach

Conditions
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Peripheral Nerve Injury

Intervention / Treatment
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* Procedure: Needle placement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA physical status 1-3 patients Diagnosis of trochanteric or cervical hip fracture Hip replacement under spinal anesthesia Exclusion Criteria: Patients under the age of 65 years or over the age of 90 years

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: in plane needle placement<br> | Procedure: Needle placement<br>* In plane versus out of plane needle placement techniques<br>|
| Experimental: out of plane needle placement<br> | Procedure: Needle placement<br>* In plane versus out of plane needle placement techniques<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of intraneural needle insertion in ultrasound-guided femoral block: out-of-plane versus in-plane approach | The incidence of needle-nerve contact is higher with the out-of-plane approach (inserting the needle into the fascia at the midpoint over the femoral nerve)needle-nerve contact than with the in-plane approach (inserting the needle lateral to the femoral nerve). | 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with femoral block success in ultrasound-guided femoral block: out-of-plane versus in-plane approach. | The efficacy of the out-of-plane approach (inserting the needle into the fascia at the midpoint over the femoral nerve)needle-nerve contact and the in-plane approach (inserting the needle lateral to the femoral nerve). | 4 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ultrasound guidance, Femoral nerve block, Needle placement, Intraneural needle insertion