NCT07217626 · University of Maryland, Baltimore
Pre-Incision Peripheral Nerve Blocks for Lower Extremity Fracture Surgery in Older Adults
What this study is about
Fractures of the lower leg are especially difficult for older adults. They are more likely to have serious complications, require longer healing times, and have a higher risk of death This occurs because their bodies cannot tolerate stress as well as younger individuals. The injury itself places significant strain on the body, and surgery adds additional stress.
View original scientific description
Fractures of the lower leg are especially difficult for older adults. They are more likely to have serious complications, require longer healing times, and have a higher risk of death This occurs because their bodies cannot tolerate stress as well as younger individuals. The injury itself places significant strain on the body, and surgery adds additional stress. Anesthesiologists use nerve blocks to help manage pain during and after these injuries. A nerve block is an injection that numbs the fracture and surgery area by blocking pain signals. These injections help patients need fewer opioid medications. However, new research shows these nerve blocks may provide benefits beyond pain management. Studies looking at older adults with hip fractures who received nerve blocks showed better overall outcomes: fewer deaths, fewer serious complications, and shorter hospital stays. However, it is not currently known if nerve blocks work this well for other broken bones in the leg, like in the thigh or shin. Additional research is need to know if nerve blocks can help patients with all types of leg fractures recover faster and experience fewer problems. Before the investigators start a large clinical trial, a small pilot study needs to be completed to determine if a larger clinical trial is feasible. This pilot study will evaluate the ability to recruit enough patients, ensure patients can receive the assigned treatment, collect data effectively, follow the study protocol, and track participants over time. The results will indicate whether the investigators are prepared to proceed with a full-scale trial and help refine the approach.
Interventions
DRUG
Local anesthesia injections
The peripheral nerve block should be performed within 2 hours before incision, either in the pre-operative holding area when called to the operating room or after positioning but prior to skin antisepsis in the operating room. The goal is to achieve an established neural blockade before surgical incision without delaying the surgical start time. All blocks must be performed using ultrasound guidance. Consistent with clinical practice, anesthesiologists will determine the appropriate balance between motor and sensory blockade based on patient factors, surgical approach, and clinical judgment.
Primary outcome measures
Feasibility of Participant Enrollment
Time frame: 12 months
Participant enrollment will be assessed by monitoring screening and enrollment metrics, including: * Initiation of screening and recruitment at the clinical site * Ability of the clinical site to screen consecutive patients 50 years of age and older with lower extremity fractures * Proportion of patients who are screened for eligibility to participate in the trial * Proportion of patients who meet the eligibility criteria * Review of reasons for exclusion * Proportion of patients who provide informed consent * Length of time required to enroll up to 50 patients
Feasibility of Treatment Allocation
Time frame: 12 months
Feasibility of the treatment allocation will be assessed using the following metrics: * Proportion of adherence to pre-incision peripheral nerve block allocation * Proportion of adherence to no peripheral nerve block allocation * Proportion of stage 2 consent acceptance rate among participants randomized to peripheral nerve blocks
Refine Data Collection Methods
Time frame: 12 months
To refine the data collection methods, the following metrics will be reviewed: * Proportion of participants with missing data * Proportion of missing data to identify data fields that are not feasible to collect * Proportion of data errors to identify ways to improve the flow of the case report forms (CRFs) and data collection
Assess Protocol Compliance
Time frame: Day 30 + 5 post-randomization
The following metrics will be used to assess compliance with the protocol: * Proportion of randomization errors * Proportion of participants who complete the 30-day follow-up phone call * Proportion of participants who withdraw from the trial (withdrawal of consent) * Proportion of participants who cannot be located (loss to follow-up)
Who can participate
This study lists these criteria on ClinicalTrials.gov. A study coordinator reviews eligibility during screening — this page does not determine whether you qualify.
Inclusion criteria
- Age ≥50 years
- Isolated fractures
- Radiographically confirmed lower extremity fracture requiring surgical fixation including:
- Femoral shaft
- Distal femur
- Proximal tibia
- Tibial shaft
- Distal Tibia
- Pilon fractures
- Ankle (malleolar fractures)
- Hindfoot/midfoot
- Acute fracture receiving definitive fixation during injury hospitalization 4\) Ability to provide informed consent (patient or legally authorized representative (LAR))
Exclusion criteria
- Contraindication to peripheral nerve block
- Infection at planned needle insertion site
- Patient refusal
- Surgeon or anesthesiologist refusal secondary to the patient's medical status
- Active peripheral nerve blockade from initial injury analgesic management is defined as: a. Risk of local anesthetic systemic toxicity
- Neurologic or vascular injuries in the affected limb
- Polytrauma with traumatic brain injury
- Thoracic injury and/or abdominal injury requiring surgical intervention
- Current enrollment in a conflicting clinical trial
- Acute or Subacute residence prior to injury
- Incarcerated at the time of enrollment
- Prior enrollment in this trial
- Unable to obtain informed consent due to language barrier
- Unable to obtain informed consent because a legally authorized representative was unavailable.
- Anticipated problems with follow-up compliance
Where
- Baltimore, Maryland
Related conditions & keywords
Frequently asked questions
What is a clinical trial?
A clinical trial is a research study that tests new medical treatments, drugs, devices, or procedures to determine their safety and effectiveness. Trials are carefully designed and monitored to protect participants while advancing medical knowledge.
Is it safe to participate?
Clinical trials follow strict safety guidelines and ethical standards. Trials must be reviewed and approved, and participants are closely monitored by medical professionals throughout the study. You can withdraw at any time if you choose.
Will I be compensated?
Many clinical trials offer compensation for your time, travel expenses, and inconvenience. The specific compensation varies by study and will be discussed during the screening process. All study-related medical care is typically provided at no cost to participants.
Will I receive a placebo instead of treatment?
When effective treatment exists, participants typically receive either the standard treatment plus the study intervention, or the standard treatment plus placebo. You would not be denied effective care. Placebos are primarily used when no proven treatment is available, or in addition to standard care. Your trial consent form will clearly explain what treatments you may receive.
Can I leave a trial if I change my mind?
Absolutely. Participation in clinical trials is completely voluntary. You have the right to withdraw from the study at any time, for any reason, without penalty or loss of benefits to which you are otherwise entitled.
How long does a clinical trial last?
Trial duration varies widely depending on the study design and purpose. Some trials last just a few weeks, while others may continue for months or years. The study coordinator will provide specific timeline information during your screening call.
Data: ClinicalTrials.gov · synced Mar 30, 2026 · Source of record for eligibility and locations