Randomised trial of clinical and cost effectiveness of Administration of Prehospital fascia Iliaca compartment block for emergency hip fracture care Delivery (RAPID2)
Pain relief of patients with hip fracture in prehospital care
Usual care Currently, when a patient who has called 999 is attended by a paramedic for a suspected hip fracture, the paramedic clinically assesses the patient, takes their history, examines them and records observations (blood pressure, heart rate, respiratory rate, oxygen saturations, Glasgow Coma Scale, patient reported pain score and temperature). Paramedics cannulate patients and provide IV fluids and/or oxygen, as appropriate, based on clinical parameters. They are currently able to provide systemic analgesia only, most commonly opioids (IV morphine), paracetamol and Entonox. In RAPID 2, patients allocated to usual care, will receive this care. Intervention care If the patient is randomly allocated to the intervention arm, the paramedic will administer FICB in addition to basic usual care as described above, but avoiding use of opioids. The FICB will utilise 1% Prilocaine and will follow the method used in the RAPID feasibility study (http://www.isrctn.com/ISRCTN60065373) (based on Dalens et al 1989). The paramedic will still provide the patient with paracetamol and Entonox but should not give the patient morphine for at least 20 minutes after the patient has received the FICB (to allow for the time of onset of Prilocaine). If, however, the FICB does not relieve the patient's pain after 20 minutes, the paramedic would be able to give the patient morphine if judged appropriate (‘rescue morphine’). Random allocation is carried out using sequentially numbered unique scratchcards, out of the sight of the patient. Both study arms will be followed up at one and four months.
Adult patients attended by a participating study paramedic following a 999 call who are: 1. Assessed as having an isolated hip fracture – hip fracture assessment checklists will be provided to aid recognition 2. Conscious (Glasgow Coma Scale Score of ≥13) 3. Haemodynamically stable 4. To be conveyed to a participating receiving hospital
1. Taking anticoagulants 2. Have a hip prosthesis on the affected side 3. Refuse analgesia 4. Are thought to be having a stroke 5. Are combative 6. Are attended by a paramedic working alone