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Femoral FractureNCT03856502

Influence of Intrathecal Dexamethasone Administration for Proximal Femoral Fractures

A study testing 8 mg of dexamethasone and 12,5 mg of 0,5 % of levobupivacaine in people with Femoral Fracture and Cognition Disorders, run by General Hospital Sveti Duh at 1 site in Croatia.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Spinal anesthesia blocks acute pain in older patients with femur fracture. Delirium is a common complication seen after femur fracture, affecting approximately 10-16% of patients. Read more about this study

Who is it for?
Ages 50 to 100 years
What is being tested?
8 mg of dexamethasone and 12,5 mg of 0,5 % of levobupivacaine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteCroatia
Study dates
11 Nov 2012to 4 Jul 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • cooperative ASA 2 and ASA 3 status patients with proximal femoral fractures of one leg
  • agreed to be enrolled in the study (Informed Consent signed)

Who cannot join

  • patients refused to be enrolled in the study
  • patients with pre-existing cognitive disturbances before surgery
  • conditions or diseases with corticosteroid therapy, long term corticosteroid, diabetes mellitus, neurological conditions or tumors, neuroendocrine disorders or tumors
  • breaking the study protocols
  • patients who no longer wanted to be enrolled in the study
  • unexpected events when the study already started

Trial locations and contacts

1 site in 1 country.

Croatia1 site
  • University Hospital "Sveti Duh"

    Zagreb, 10000

Other trials in Croatia

About this study

Official title: Impact of Intrathecal Dexamethasone Administration for Elderly Patients With Proximal Femoral Fracture

Spinal anesthesia blocks acute pain in older patients with femur fracture. Delirium is a common complication seen after femur fracture, affecting approximately 10-16% of patients. It is associated with increased mortality at 1st year, delayed rehabilitation efforts, prolonged length of hospital stay, poorer functional outcomes, and increased risk of nursing home placement.

Intrathecal dexamethasone administration improves quality of anesthesia in patients with femur fracture compared to conventional spinal anesthesia.

Read the detailed description

The aim of this research was to establish the influence of intrathecal dexamethasone administration in spinal anaesthesia with levobupivacaine on postoperative pain and changes of consciousness, values of cortisol levels and quality of treatment for patients with femoral fractures compared to spinal anaesthesia with only local anaesthetic.

The study was planned as a prospective, observational, randomised clinical trial. A total of 60 patients ASA2 and ASA3 status, scheduled for surgical procedures were sorted into two groups and underwent surgery in spinal anesthesia with levobupivacaine with or without dexamethsone.

Being tested
8 mg of dexamethasone, 12,5 mg of 0,5 % of levobupivacaine
Keywords
spinal anesthesia, femoral fracture, dexamethasone
Medical subject headings
Femoral Fractures, Cognition Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • 8 mg of dexamethasoneDrug

    Also called Dexamethasone KRKA, Chirocaine Abbott

    Effect of intrathecally administered dexamethasone in spinal anaesthesia for surgical correction of the hip fracture.

  • 12,5 mg of 0,5 % of levobupivacaineDrug

    Also called Chirocaine Abbott

    Local anaesthetic standardly used in spinal anaesthesia for surgical correction of the hip fracture by the particular hospital's protocol.

Study groups in NCT03856502
Study groupRoleWhat they receive
group that received dexamethasone (DLSA)ExperimentalThe study group of 30 patients ASA status 2 or 3 received 8 mg of dexamethasone with 12,5 mg of 0,5% of levobupivacaine intrathecally for surgical reconstruction of proximal femoral fracture. Spinal anaesthesia was performed in sitting position using middle approach in intervertebral space L2-L3 or L3-L4 with spinal needles 22-27 GA.
Receives: Drug: 8 mg of dexamethasone; Drug: 12,5 mg of 0,5 % of levobupivacaine
group without dexamethasone (LSA)Active comparatorThe control group of 30 patients ASA status 2 or 3 received 12,5 mg of 0,5% of levobupivacaine intrathecally for surgical reconstruction of proximal femoral fracture. Spinal anaesthesia was performed in sitting position using middle approach in intervertebral space L2-L3 or L3-L4 with spinal needles 22-27 GA.
Receives: Drug: 12,5 mg of 0,5 % of levobupivacaine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. postoperative cognitive change

    Assessed using a simplified Confusion Assessment Method scoring scale, a clinical instrument for delirium assessment used by non-psychiatric medical staff after surgery for excluding delirium. Delirium is defined in terms of 4 possible diagnostic criteria (1. acute onset or fluctuating course; 2- inattention; 3- disorganised thinking; 4- altered level of consciousness (may be defined as alert, lethargic, stupor or coma cognitive state)) and is defined as present when 1 plus 2 and either 3 or 4 diagnostic criteria are positive.

    Measured: Confusion Assessment Method scoring was assessed in 4 measure points: 1. one hour after surgery, 2. on the 3rd postoperative day at 9 am, 3. on the 5th postoperative day at 9 am, 4. on the 10th postoperative day at 9 am

  2. cortisol concentrations changes

    Determined from patient's blood plasma assessed by Roche Elecsys Immunoassay System and defined from the laboratory reference points (185-624)nmol/L equal for each measure point; for single measuring 0,5 ml of patient's blood was taken

    Measured: Measured in 5 measure points: 1. one hour before surgery, 2. one hour after surgery, 3. on the 3rd postoperative day at 6 am, 4. on the 5th postoperative day at 6 am, 5. on the 10th postoperative day at 6 am

Secondary outcomes (10)
  1. perioperative pain intensity: Visual Analogue Scale score

    Assessed using Visual Analogue Scale score and establishing postoperative analgesic requirements

    Measured: Visual Analogue Scale scoring (scores: 0-10) was assessed in 5 measure points every 3 hours when patient was awake: 1. 1 h before surgery, 2. 1 h after surgery, 3. on the 3rd postoperative day, 4. on the 5th postoperative day, 5. 10th postoperative day

  2. glucose concentrations changes

    Determined form patient's blood plasma assessed by Beckman Coulter AU400 and AU680 orbOlympus Glucose Analyzer 2 devices defined from the laboratory reference points (4,4-6,4)mmol/L equal for each measure point; for single measuring 0,2 ml of patient's blood was taken

    Measured: Measured in 5 measure points (units: mmol/L): 1. one hour before surgery, 2. one hour after surgery, 3. on the 3rd postoperative day at 6 am, 4. on the 5th postoperative day at 6 am, 5. on the 10th postoperative day at 6 am

  3. Blood loss

    Determinated by intraoperative blood loss in mililitres, amount of blood in drainage systems in mililitres, transfusion of homologous blood in mililitres

    Measured: During the surgical repairment and up to the removal of drainage systems (2nd postoperative day)

  4. Number of Participants with pulmonary embolism

    Established by noted pulmonary embolism in the operating room or at the traumatology ward by the ward staff

    Measured: During surgical reconstruction and during postoperative follow-up of up to ten postoperative days

  5. Number of Participants with heart failure

    Established by noted heart failure in the operating room or at the traumatology ward by the ward staff

    Measured: During surgical reconstruction and during postoperative follow-up of up to ten postoperative days

  6. Platelets changes

    Determined from laboratory values of platelets data in reference points (158-424)10^9/L equal for each measure point

    Measured: Assessed in 5 measure points: 1.one hour before surgery, 2. one hour after surgery, 3. on the 3rd postoperative day at 6 am, 4. on the 5th postoperative day at 6 am, 5. on the 10th postoperative day at 6 am

  7. Haemoglobin changes

    Determined from laboratory values of haemoglobin data measured reference points (119-157)g/L equal for each measure point

    Measured: Assessed in 5 measure points: 1.one hour before surgery, 2. one hour after surgery, 3. on the 3rd postoperative day at 6 am, 4. on the 5th postoperative day at 6 am, 5. on the 10th postoperative day at 6 am

  8. Haematocrit changes

    Determined from laboratory values of haematocrit data in reference points (0,356-0,470)L/L equal for each measure point

    Measured: Assessed in 5 measure points: 1.one hour before surgery, 2. one hour after surgery, 3. on the 3rd postoperative day at 6 am, 4. on the 5th postoperative day at 6 am, 5. on the 10th postoperative day at 6 am

  9. Hospitalisation

    Calculated by number of days preoperatively from the day of admission to the day of surgical treatment and postoperatively from the day of surgical treatment to the day of hospital discharge

    Measured: In the time period of up to 30 days

  10. Number of Participants who underwent surgical procedure during first 48 hours from admission

    It was defined if surgical procedure was performed in first 48 hours from admission to the hospital's Emergency Department or later reflecting morbidity and/or mortality

    Measured: Calculated in hours after the patient's admission to the hospital's Emergency Department to the point of surgical reconstruction in the time period up to 48 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Feb 2019
  2. Study start11 Nov 2012
  3. Primary completion26 May 2016
  4. Study completion4 Jul 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03856502
Sponsor's protocol ID
662809198348
Status last verified
Feb 2019
First submitted
2 Nov 2018
Last updated
28 Feb 2019
Results posted
No
Individual data sharing
No: The research has been a doctoral thesis.

Publications

  • Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012 Jul;117(1):72-92. doi: 10.1097/ALN.0b013e3182545e7c.

    PubMed 22713634
  • Membership of the Working Party; Griffiths R, Alper J, Beckingsale A, Goldhill D, Heyburn G, Holloway J, Leaper E, Parker M, Ridgway S, White S, Wiese M, Wilson I. Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2012 Jan;67(1):85-98. doi: 10.1111/j.1365-2044.2011.06957.x.

    PubMed 22150501
  • Borgeat A, Ekatodramis G. Orthopaedic surgery in the elderly. Best Pract Res Clin Anaesthesiol. 2003 Jun;17(2):235-44. doi: 10.1016/s1521-6896(03)00007-7.

    PubMed 12817917
  • Baumann H, Gauldie J. The acute phase response. Immunol Today. 1994 Feb;15(2):74-80. doi: 10.1016/0167-5699(94)90137-6.

    PubMed 7512342
  • Buckingham JC. Stress and the hypothalamo-pituitary-immune axis. Int J Tissue React. 1998;20(1):23-34. No abstract available.

    PubMed 9561443
  • Munck A, Guyre PM, Holbrook NJ. Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev. 1984 Winter;5(1):25-44. doi: 10.1210/edrv-5-1-25.

    PubMed 6368214
  • Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000 Jul;85(1):109-17. doi: 10.1093/bja/85.1.109. No abstract available.

    PubMed 10927999
  • Hogevold HE, Lyberg T, Kahler H, Haug E, Reikeras O. Changes in plasma IL-1beta, TNF-alpha and IL-6 after total hip replacement surgery in general or regional anaesthesia. Cytokine. 2000 Jul;12(7):1156-9. doi: 10.1006/cyto.2000.0675.

    PubMed 10880268
  • Kehlet H. Manipulation of the metabolic response in clinical practice. World J Surg. 2000 Jun;24(6):690-5. doi: 10.1007/s002689910111.

    PubMed 10773121
  • Bani-Hashem N, Hassan-Nasab B, Pour EA, Maleh PA, Nabavi A, Jabbari A. Addition of intrathecal Dexamethasone to Bupivacaine for spinal anesthesia in orthopedic surgery. Saudi J Anaesth. 2011 Oct;5(4):382-6. doi: 10.4103/1658-354X.87267.

    PubMed 22144925
  • Kroin JS, Schaefer RB, Penn RD. Chronic intrathecal administration of dexamethasone sodium phosphate: pharmacokinetics and neurotoxicity in an animal model. Neurosurgery. 2000 Jan;46(1):178-82; discussion 182-3.

    PubMed 10626948
  • Yao XL, Cowan MJ, Gladwin MT, Lawrence MM, Angus CW, Shelhamer JH. Dexamethasone alters arachidonate release from human epithelial cells by induction of p11 protein synthesis and inhibition of phospholipase A2 activity. J Biol Chem. 1999 Jun 11;274(24):17202-8. doi: 10.1074/jbc.274.24.17202.

    PubMed 10358078
  • Dong Y, Zhang X, Tang F, Tian X, Zhao Y, Zhang F. Intrathecal injection with methotrexate plus dexamethasone in the treatment of central nervous system involvement in systemic lupus erythematosus. Chin Med J (Engl). 2001 Jul;114(7):764-6.

    PubMed 11780346
  • Williams BA, Hough KA, Tsui BY, Ibinson JW, Gold MS, Gebhart GF. Neurotoxicity of adjuvants used in perineural anesthesia and analgesia in comparison with ropivacaine. Reg Anesth Pain Med. 2011 May-Jun;36(3):225-30. doi: 10.1097/AAP.0b013e3182176f70.

    PubMed 21519308
  • Benzon HT, Chew TL, McCarthy RJ, Benzon HA, Walega DR. Comparison of the particle sizes of different steroids and the effect of dilution: a review of the relative neurotoxicities of the steroids. Anesthesiology. 2007 Feb;106(2):331-8. doi: 10.1097/00000542-200702000-00022.

    PubMed 17264728

Questions about this trial

What is this clinical trial studying?

A study testing 8 mg of dexamethasone and 12,5 mg of 0,5 % of levobupivacaine in people with Femoral Fracture and Cognition Disorders, run by General Hospital Sveti Duh at 1 site in Croatia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Feb 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Croatia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

postoperative cognitive change (time frame: Confusion Assessment Method scoring was assessed in 4 measure points: 1. one hour after surgery, 2. on the 3rd postoperative day at 9 am, 3. on the 5th postoperative day at 9 am, 4. on the 10th postoperative day at 9 am). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03856502, which also lists 24 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2019.

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