A higher number than expected of patients with hip fracture have only insufficient analgesic effect of a femoral nerve block, which is the nerve block commonly used for this group of patients. One of the possible causes of this failure to provide analgesia from a single nerve block could be the that other nerves are involved in transmitting the pain signal. One of the nerves that is believed to give off branches to the hip is the obturator nerve. With ultrasound it is possible to make a selective proximal nerve block of the obturator nerve. The aim of this trial is to test the analgesic effect of a femoral nerve block i combination with an obturator nerve block compared to femoral nerve block alone in a randomized and placebo controlled design.
A higher number than expected of all patients with hip fracture have only insufficient analgesic effect of a femoral nerve block. One of the possible causes of this failure to provide analgesia from a single nerve block could be the that other nerves are involved in transmitting the pain signal. One of the nerves that is believed to give off branches to the hip is the obturator nerve. Earlier it was believed that the so called '3-in-1-block' or the iliac fascia compartment block would anesthetize also the obturator nerve, and these two nerve blocks have been uses extensively in the emergency ward for preoperative analgesia. Today that is not believed to be true and consequently is the part of the obturator nerve in patients with hip fracture unknown. With ultrasound it is possible to make a selective proximal nerve block of the obturator nerve before it branches into an anterior and a posterior branch. A selective nerve block of the obturator nerve to access its effect in patients with hip fracture has to our knowledge never been done. The aim of this trial is to test the analgesic effect of a femoral nerve block i combination with an obturator nerve block compared to femoral nerve block alone in a randomized and placebo controlled design.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
90
Obturator nerve block
Obturator nerve block with saline(placebo)
Aarhus University Hospital
Aarhus, Aarhus, Denmark
RECRUITINGSuccess rate of successful analgesia, measured with numeric rating scale(NRS) 0-10 with 0=no pain and 10=worst pain. Successful analgesia = NRS<4 at rest and NRS <6 with passive movement of the fractured leg.
Success rate of successful analgesia compared between the groups
Time frame: 30 minutes
Median pain score (NRS 0-10)
Median pain score 30 minutes after the nerve blocks compared between the groups
Time frame: 30 minutes
Median change in pain score (NRS 0-10)
Median change in pain score 30 minutes after the nerve blocks compared between the groups
Time frame: 30 minutes
Course in pain reduction
Course in pain reduction during the 30 minutes after the nerve blocks
Time frame: 30 minutes
Time to sufficient analgesia
Time from ended injection until sufficient analgesia
Time frame: 30 minutes
Frequency of anesthesia in the skin area of the saphenous nerve
Frequency of anesthesia in the skin area innervated by the saphenous nerve
Time frame: 30 minutes
Frequency of anesthesia in the skin area of the anterior cutaneous branches of the femoral nerve
Frequency of anesthesia in the skin area of the anterior cutaneous branches of the femoral nerve
Time frame: 30 minutes
Localization of the worst pain before block
Localization of the worst pain before any nerve blocks
Time frame: 0 minutes
Localization of the worst pain after block
Localization of the worst pain 30 minutes after the nerve blocks
Time frame: 30 minutes
Discomfort during nerve block procedures (score 0-10, 0=no discomfort)
Discomfort during the nerve block procedures compared between procedures
Time frame: 5 minutes
Satisfaction (0-10, 0= very unsatisfactory)
Patient satisfaction with the pain treatment
Time frame: 30 minutes
Frequency of ultrasound visualization of femoral nerve
Frequency of patients with possible ultrasound visualization af the femoral nerve
Time frame: 5 minutes
Frequency of ultrasound visualization of obturator injection site
Frequency of patients with possible ultrasound visualization of the obturator nerve block injection site
Time frame: 5 minutes
Time spend on femoral nerve block
Time spend on conducting the femoral nerve block
Time frame: 5 minutes
Time spend on obturator nerve block
Time spend on conducting the obturator nerve block
Time frame: 5 minutes
Total morphine equivalent dose of opioid from the time of nerve block to operation
Total morphine equivalent dose of opioid from the time of nerve block until the time of operation
Time frame: Approximately 24 hours in average
Total morphine equivalent dose of opioid/time from the time of nerve block to operation
Total morphine equivalent dose of opioid/time from the time of nerve block until the time of operation
Time frame: Approximately 24 hours in average
Total morphine equivalent dose of opioid in the first 10 hours after nerve block
Total morphine equivalent dose of opioid given in the first 10 hours after nerve block
Time frame: 10 hours
Total morphine equivalent dose of opioid/time in the first 10 hours after nerve block
Total morphine equivalent dose of opioid/time given in the first 10 hours after nerve block
Time frame: 10 hours
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