Fractured Neck of Femur Clinical Trial
Official title:
Optimal Positioning of Local Anaesthetic in Femoral Nerve Block Prior to Operative Fixation of Fractured Neck of Femur
The aim of the study is to compare patient comfort and analgesic efficacy of ultrasound guided femoral nerve block using the following endpoints: circumferential spread, anterior or posterior local anaesthetic deposition prior to positioning for spinal anaesthesia for operative fixation of fractured neck of femur.
Fractured neck of femur is a common cause of admission to hospital in elderly patients and
requires operative fixation. The recommended anaesthetic technique for these cases is spinal
anaesthesia, which is performed with the patient in lateral decubitus. Positioning the
patient prior to administering spinal anaesthesia is the most painful manouvre due to the
movement of the fractured bone.
Regional anaesthesia is effective in alleviating pain due to trauma, and it has the
advantage of producing localized but complete pain relief (1). Femoral nerve blockade prior
to positioning for spinal anaesthesia provides excellent pain relief and is a well tolerated
procedure (2-5).
Using ultrasound guided femoral nerve block is a relative new method to improving the block
success rate. It is widely used in our hospital. In a recent study Casati and al. showed a
42 % decrease of ED50% using ultrasound for localization of the femoral nerve (6). In a
recent editorial by Brian D. Sites was mentioned that the positioning of the local
anaesthetic in ultrasound guided blocks is unclear (7). We currently follow different
patterns in relation to injection of the local anaesthetic solution around the femoral
nerve. One of them is a circumferencial spread around the nerve. This, however, needs
several needle passes which are likely to be painful for the patient. Another option is
injecting the local anaesthetic on one side, above or below the nerve without changing the
position of the tip of the needle, avoiding patient discomfort. Whether this results in a
comparable quality of sensory block is unknown. The femoral nerve is separated in branches
at this level and we assume that the spread of local anaesthetic may influence the quality
and the distribution of the block. We propose to study the characteristics of femoral nerve
block in relation to different patterns of local anaesthetic injection (circumferencial,
inferior or superior).
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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