Summary
Rapid Analgesia for Prehospital Hip Disruption
Funder: HCRW
Background and study aims
Breaking a hip is very painful. Patients who break their hip will often call 999 and be taken to hospital by an ambulance. Sadly, research has shown that paramedics do not always give patients with a broken hip adequate pain relief. Fascia iliaca compartment block (FICB) has been tested in a few small studies recently. It has been shown to be a safe and effective method of giving pain relief to patients with hip fracture. FICB involves finding a soft tissue ‘compartment’ which lies over the hip. This is done using bony landmarks and feeling resistance from a needle. The person giving the FICB will feel two ‘pops’ as the needle goes through two tissue layers (fascias). Local anaesthetic is then injected into this ‘compartment’ with the aim of blocking sensation to three nerves in this area (femoral, obturator, lateral femoral cutaneous). The patient will then not be able to feel pain from their hip. This study involves paramedics giving FICB to some patients who break their hip. It is possible that FICB could give better pain relief to patients who break their hip than what patients are given in current practice (usually morphine). FICB could also reduce the amount of morphine given to patients who break their hip. This would benefit patients because morphine has several side effects (feeling sick, giddy or confused, being constipated or having trouble breathing). This study will also investigate whether FICB has any long term benefits by comparing death rates, general health and mobility of patients 30 days after the injury. It will also look at whether it would be possible and worthwhile to carry out a bigger trial involving a number of trial participating centres.
Who can participate?
Adult patients assessed by a paramedic as having a hip fracture.
What does the study involve?
Participants are randomly allocated into one of two groups. Those in group 1 are given standard pain relief (usually morphine). Those in group 2 are given FICB. If the FICB does not work within 15-20 minutes, they may also be given morphine. All participants can be given paracetamol and Entonox (other types of painkillers) as required. Once they reach the hospital, a nurse asks them to assess their pain levels by giving a score between 0 (no pain) to 10 (worst pain imaginable). All patients are then followed up 30 days later to record the number of people who have died, their general state of health and how mobile they now are after the fracture.
What are the possible benefits and risks of participating?
Trial participants who receive the local anaesthetic injection instead of morphine may benefit from superior pain relief or better long term outcomes as a result of taking part in the trial, but we do not know for sure – that is why we are carrying out this research. There are risks of having a local anaesthetic injection such as nerve damage (short term or long term) and bleeding, which are rare. A more common side effect is bruising around the site of the injection.
Where is the study run from?
Swansea University (UK)
When is the study starting and how long is it expected to run for?
October 2015 to September 2017
Contact Details
Trial Manager / Lead Contact: Nigel Rees
Email: Nigel.Rees5@wales.nhs.uk
Website: https://www.researchgate.net/profile/Nigel_Rees
ISCRTN Number: 60065373 ;