Patients With Acute Hip Fractures Will Receive Either the PENG Block or no Block Respectively.

Study Overview
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Brief Summary
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Hip fracture pain is often severe and traditionally managed by systemic opioids which have increased risk of side effects in frail elderly patients. Inadequately controlled pain may lead to delirium which increases mortality and morbidity. The overall aim of this RCT is to investigate the potential for improved pain relief accomplished by the addition of the PENG block to current standard practice of pre-operative analgesia (systemic morphine), compared to the control group, which involves no block (operator will still go through the motion as if performing a block) plus standard pre-operative analgesia. The investigator hypothesize that the addition of a single shot PENG block at the side of hip fracture in addition to traditional systemic morphine provides good preoperative pain relief on movement and reduces the need for breakthrough opioid requirements. The investigator hypothesize that the interventional group dynamic pain score assessed at 30 minutes after the block compared to control group dynamic pain score at 30 minutes after the block will be at least a 3 point difference between the 2 groups .

Detailed Description
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Specific Aim1: To determine difference in pain scores on movement (dynamic pain scores) in patients who receive the PENG block in the intervention group compared to no block in the control group at 30 minutes after performance of the block. Specific Aim2: To determine if there is any difference in pain at rest between the intervention group and the control group, and if so, the magnitude of the difference in pain scores.

Official Title
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Evaluation of the PENG Block vs Placebo for Preoperative Pain Control in Hip Fractures in the Elderly - a Double-blinded Randomised Controlled Trial

Conditions
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Hip Fractures

Intervention / Treatment
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* Drug: Ropivacaine 0.5% Injectable Solution
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 60 years old and above Provided consent for the study Patients with solitary hip fracture (no other fracture) - intracapsular neck of femur fracture, intertrochanteric fracture Either awaiting hip fracture surgery or no plans for hip fracture surgery within the next 24 hours Exclusion Criteria: Patients with cognitive impairment or inability to give consent, or refusal to give consent Multiple fracture cases Peri-prosthetic fractures and revisions Subclinical vertebral fractures Hip fractures due to major accidents such as road traffic accidents, fall from height or more than 2 meters Multiple trauma Pathological fractures secondary to metastases Patients with contraindications to block performance Coagulopathy as demonstrated by PT/PTT/INR On antiplatelets or anticoagulation Infection/ compromised skin integrity at site of block performance Allergy to local anaesthetics and opioids

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Control<br>Only standard care | Drug: Placebo<br>* Standard care<br>* Other names: Standard care;|
| Experimental: Intervention group<br>The PENG block was performed for intervention group with local anaesthetic solution composed of 20 ml of ropivacaine 0.5%. | Drug: Ropivacaine 0.5% Injectable Solution<br>* Local anaesthetic solution composed of ropivacaine 0.5%(intervention group)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dynamic pain scores (Numerical pain score (NRS) at 15 degrees leg lift) | The difference in dynamic pain scores (NRS at 15 degrees leg lift) at 30 minutes post block performance in the intervention group vs the control group. Assessment of the dynamic pain score is done prior to discharge from recovery at SGH Pain Management Centre. | 30 minutes after receiving intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain scores (NRS) at rest (static pain) and on movement (dynamic pain) | It is measured at Baseline, Immediately after performance of block, 30 minutes after the lock in recovery At 60 minutes, 180 minutes and 24 hours post block in the ward | Up to 24 hours from performance of block | 
| Pain scores collected to estimate the onset and duration of block Pain scores to estimate the onset and duration of block | Taking the recorded time taken for the pain relieve to estimate onset time using models | Up to 24 hours from performance of block | 
| Total opioid use over 24 hours as a surrogate measure | Using the data recorded for : Oral morphine use Intravenous morphine use for patients on PCA Doses of opioid use will be converted to morphine milligram equivalent daily dose (MEDD) for standardized comparison. | Up to 24 hours from performance of block | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hip fractures, elderly, pain