Brachial Plexus Nerve Block versus Standard Care for Closed Reduction of Distal Radius Fracture in Adults - BLOCK Trial. et nasjonalt multisenter randomisert kontrollert forsøk
The aim of the project is to evaluate the beneficial and harmful effects of an ultrasound-guided brachial plexus nerve block for patients with a distal radius (wrist) fracture in the need of realignment of fractured bone endings without cutting the skin (closed reduction), in comparison to a haematoma block, which is standard care in Denmark.
Every participant will receive one of the following types of anaesthesia for the realignment of the wrist fracture:
- A nerve block of the arm (plexus brachialis block)
- A haematoma block, which is the current standard anaesthesia in the emergency departments.
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Studietype
Registrering (Antatt)
Fase
- Fase 4
Kontakter og plasseringer
Studiesteder
-
-
Capital Region
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Hillerød, Capital Region, Danmark, 3400
- Copenhagen University Hospital - North Zealand Hillerød
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-
Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Adults (age ≥ 18 years) with a distal radius fracture in need of closed reduction
Exclusion Criteria:
- Patients who would never qualify for surgery according to local guidelines
- Lack of informed consent
- No Danish Central Person Register (CPR) number
- Allergies to the trial medication
- Distal radius fracture initially deemed to require surgery regardless of the outcome of the closed reduction
- Open fractures (fracture-related wound requiring sutures)
- Other fractures on the same extremity ((NOT including distal ulna fracture(s))
- Bilateral distal radius fractures both requiring closed reduction
- Concomitant medical or surgical condition taking priority over the closed reduction of the distal radius fracture.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Dobbelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
|
Eksperimentell: Intervention group
Ultrasound-guided brachial plexus nerve block. A total of 30 ml of lidocaine (10 mg/ml) with adrenaline (5 ug/ml) will be administered in multiple injections. |
The block will be performed as either a lateral infraclavicular brachial plexus block or an axillary brachial plexus block |
|
Aktiv komparator: Control group
Haematoma block with local anaesthetics i.e. lidocaine with adrenaline |
Participants will receive no peripheral nerve block and receive a haematoma block, with or without supplemental sedation and/or systemic analgesia for the closed reduction according to local guidelines and clinical practices |
Hva måler studien?
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Kumulativ andel pasienter med distal radiusfrakturoperasjon
Tidsramme: 90 dager etter stengt reduksjon
|
90 dager etter stengt reduksjon
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Composite outcome of treatment related complications
Tidsramme: 90 days after closed reduction
|
loco-regional neurological complications from affected arm, local anaesthetic systemic toxicity, soft tissue injuries (including skin injuries) related to the closed reduction procedure, infection at the site of needle puncture, vessel puncture requiring subsequent treatment (including compression), pneumothorax, allergic reaction, new bone or joint injury (e.g. dislocation or fracture) after the closed reduction and/or pulmonary embolism |
90 days after closed reduction
|
|
Patient Rated Wrist Evaluation (PRWE)
Tidsramme: 90 days after closed reduction
|
The PRWE is a patient-reported outcome and the PRWE-score is calculated from the Danish-validated translation of the PRWE questionnaire |
90 days after closed reduction
|
|
Maximum pain score in the affected wrist during closed reduction(s)
Tidsramme: 0-12 hours after the closed reduction
|
The pain outcomes are patient-reported as a Numerical Rating Scale (NRS) score on a scale from 0=no pain to 10=worst pain imaginable. If the patient has the closed reduction performed more than one time, the patient will be asked to report the worst pain experienced during all the attempts of a closed reduction. |
0-12 hours after the closed reduction
|
|
Proportion of patients with unacceptable radiographic fracture position immediately after closed reduction
Tidsramme: 0 -24 hours after closed reduction
|
The radiographic fracture position is evaluated according to the American Academy of Orthopaedic Surgerons (AAOS) guidelines. The fracture position is unacceptable if the fracture has a radial shortening > 3 mm, > 10 degrees dorsal tilt of the articular surface of radius from a perpendicular line on the longitudianal axis of radius or intra-articular displacement or step-off > 2 mm. |
0 -24 hours after closed reduction
|
Andre resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Antall forsøk brukt for lukket reduksjon
Tidsramme: Umiddelbart etter lukket reduksjon
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Umiddelbart etter lukket reduksjon
|
|
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Andel individuelle komplikasjoner i det sammensatte sekundære utfallet
Tidsramme: 90 dager etter stengt reduksjon
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90 dager etter stengt reduksjon
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|
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Pain at rest in the affected wrist immediately, 90 days, and 12 months after closed reduction
Tidsramme: 0-12 hours, 90 days and 12 months after closed reduction
|
The pain outcomes are patient-reported as a Numerical Rating Scale (NRS) score on a scale from 0=no pain to 10=worst pain imaginable. |
0-12 hours, 90 days and 12 months after closed reduction
|
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Maximum pain in the affected wrist within the first 24 hours after closed reduction
Tidsramme: 24-36 hours after the closed reduction.
|
The pain outcomes are patient-reported as an NRS score on a scale from 0=no pain to 10=worst pain imaginable. |
24-36 hours after the closed reduction.
|
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Proportion of patients with complex regional pain syndrome (CRPS)
Tidsramme: 90 days and 12 months after closed reduction
|
CRPS is defined according to the Budapest Criteria |
90 days and 12 months after closed reduction
|
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Disabilities of the Arm, Shoulder, and Hand (DASH) score
Tidsramme: 90 days and 12 months after closed reduction
|
DASH-score is calculated from the Danish-validated translation of the DASH questionnaire |
90 days and 12 months after closed reduction
|
|
Patient Rated Wrist Evaluation (PRWE)
Tidsramme: 12 months after closed reduction
|
PRWE-score is calculated from the Danish-validated translation of the PRWE questionnaire |
12 months after closed reduction
|
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Quality of life (EQ-5D-5L) score
Tidsramme: 90 days and 12 months after closed reduction
|
The Danish translation of the EQ-5D-5L questionnaire is used and the EQ-5D-5L-score is calculated based on the Danish EQ-5D-5L value set |
90 days and 12 months after closed reduction
|
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Difficulty of closed reduction of the fracture
Tidsramme: Immediately after closed reduction
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The doctor reported ease on a numeric rating scale from 0-10; 0=very easy, 10=very difficult) |
Immediately after closed reduction
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Discomfort related to the anaesthetic procedure
Tidsramme: 0-12 hours after closed reduction
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The discomfort is a patient-reported outcome on a numeric rating scale from 0-10; 0=no discomfort, 10=very uncomfortable |
0-12 hours after closed reduction
|
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Overall satisfaction with the treatment 0 to 24 hours after initiation of the anaesthesia
Tidsramme: 24 hours after closed reduction
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The overall satisfaction is a patient-reported outcome on a numeric rating scale from 0-10; 0=very unsatisfied, 10=very satisfied. When evaluating the treatment, the patient is specifically asked to include all elements of the treatment including: the anaesthetic (procedure and following effects), the experience during the closed reduction and the pain and general sensation in the arm/wrist in the first 24 hours after the treatment commencement. |
24 hours after closed reduction
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Proportion of patients with unacceptable radiographic position at first follow-up in the orthopaedic out-patient clinic (typically 10-14 days post-reduction)
Tidsramme: 10-14 days after closed reduction
|
The radiographic fracture position is evaluated according to the American Academy of Orthopaedic Surgerons (AAOS) guidelines. The fracture position is unacceptable if the fracture has a radial shortening > 3 mm, > 10 degrees dorsal tilt of the articular surface of radius from a perpendicular line on the longitudianal axis of radius or intra-articular displacement or step-off > 2 mm. |
10-14 days after closed reduction
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Proportion of patients having one or more serious adverse events (SAEs), including events related to loss of hand function
Tidsramme: Within 90 days after closed reduction
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A SAE is defined as an adverse event that leads to the following incidents:
Surgical reduction of the distal radius fracture, including relevant admission to hospital, will not be catagorised as a SAE. |
Within 90 days after closed reduction
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Proportion of patients having one or more adverse events (AEs)
Tidsramme: Within 24 hours after closed reduction
|
An AE is defined as any harmful and unintended event, sign, or symptom, that appear during the trial period, regardless of whether this AE is considered related to the treatment or not. |
Within 24 hours after closed reduction
|
Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Hovedetterforsker: Cecilie D Harwood, MD, PhD-fellow, Copenhagen University Hospital - North Zealand
- Hovedetterforsker: Anne-Sofie Jellestad, MD, PhD-fellow, Copenhagen University Hospital - North Zealand
Publikasjoner og nyttige lenker
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Antatt)
Studiet fullført (Antatt)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- CTA no: 2024-512191-35-00
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