E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Hip surgery anaesthesia and perioperative analgesia |
Hoftekirurgisk anæstesi og perioperativ analgesi |
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E.1.1.1 | Medical condition in easily understood language |
Anaesthesia for hip surgery and perioperative pain treatment |
Bedøvelse til hoftekirurgi og smertebehandling før og efter kirurgien |
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E.1.1.2 | Therapeutic area | Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] - Anesthesia and Analgesia [E03] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10036284 |
E.1.2 | Term | Post-operative hip pain |
E.1.2 | System Organ Class | 100000004863 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10051060 |
E.1.2 | Term | Hip surgery |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
A double blinded, randomized controlled trial of success for lumbar plexus block (L2-L4) of the femoral, obturator, and lateral femoral cutaneous nerves with ultrasound/MRI image fusion guided Shamrock method vs. ultrasound guided Shamrock method. Success is assessed as motor block of the femoral and obturator nerves and sensory block of the lateral femoral cutaneous nerve in healthy volunteers. |
Dobbeltblindet, randomiseret og kontrolleret undersøgelse af succes for plexus lumbalis blokade (L2-4) af nn. femoralis, obturatorius og cutaneus femoris lateralis med Shamrock metoden vejledt af ultralyd/MR billedfusion vs. vejledning af ultralyd alene. Succes vurderes i raske, frivillige forsøgspersoner som motorisk blokade af n. femoralis og n. obturatorius samt sensorisk blokade af n. cutaneus femoris lateralis. |
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E.2.2 | Secondary objectives of the trial |
To estimate: • Time for preparation of block • Time for block procedure • Minimal electrical nerve stimulation for release of neuromuscular response • Type of neuromuscular response on electrical nervestimulation • Number of needle proceedings • Depth of block needle • Distance between injection site in skin to the sagittal midline • Discomfort during block procedure • Middlearterial bloodpressure • Perineural spread of local anaesthetics • Epidural spread of local anaesthetics • Motor block of the af femoral, obturator, superior gluteal and sciatic nerves • Sensory block of the dermatomes T8-S3 and the lateral femoral cutaneous nerve • Cost-effectiveness • Reproducibility of diffusion weighted MRI sequences for ultrasound/MRI image fusion guided Shamrock method vs ultrasound guided Shamrock method in healthy volunteers. |
• Forberedelsestid før blokaden • Anlæggelsestid for blokaden • Minimal elektrisk nervestimulation for udløsning af neuromuskulært respons • Type neuromuskulært respons på elektrisk nervestimulation • Antal nålefremføringer under blokadeanlæggelsen • Dybde af nåleindstik under blokadeanlæggelsen • Afstand fra indstik i huden til den sagittale midtlinje • Ubehag under blokadeanlæggelsen • Middelarterielt blodtryk (MAP) • Perineural spredning af lokalanalgetikum • Epidural spredning af lokalanalgetikum • Motorisk blokade af nn. femoralis, obturatorius, glutealis superior og ischiadicus • Sensorisk blokade af dermatomerne T8-S3 og n. cutaneus femoris lateralis • Cost-effectiveness • Reproducerbarhed af diffusionsvægtede MR-skanningssekvenser i den enkelte deltager for Shamrock metoden vejledt af ultralyd/MR billedfusion vs. vejledning af ultralyd alene |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Age ≥ 18 years • Body mass index (BMI): 18.5 ≤ BMI ≤30 • Written and oral consent to participate • Normal healthy person (American Society of Anesthesiology [ASA] Classification I) |
• Alder ≥ 18 år • Body mass index: 18.5 ≤ BMI ≤30 • Skriftligt og mundtligt samtykke til at deltage • Normal rask person (American Society of Anesthesiology [ASA] Classification I) |
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E.4 | Principal exclusion criteria |
• Volunteers not abel to speak or understand Danish • Volunteers not able to cooperate • Allergy against the medicines used in the study • Daily use of analgesics • Drug abuse – according to the investigator's judgment • Alcohol consumption greater than the recommendations of the Danish National Board of Health • Contraindication for MRI scan (including pregnancy) • Volunteers in whom nerve blocks are impossible due to technical reasons or infection • Volunteers who are incompetent, eg. surrogate consent is unaccepted |
• Forsøgspersoner som ikke forstår og taler dansk • Forsøgspersoner som ikke kan samarbejde til undersøgelsen • Allergi overfor de i undersøgelsen nævnte stoffer • Dagligt forbrug af analgetikum • Medicinmisbrug – efter investigators skøn • Større alkoholforbrug end Sundhedsstyrelsens retningslinjer, det vil sige > 14 genstande ugentlige for mænd og > 7 genstande ugentligt for kvinder • Kontraindikation mod MR scanning inklusive graviditet • Forsøgspersoner hvor det på grund af tekniske forhold ikke er muligt at anlægge en lumbal nerveblokade • Inhabilitet, det vil sige at der ikke kan benyttes stedfortrædendes samtykke |
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E.5 End points |
E.5.1 | Primary end point(s) |
Block success of the clinical relevant lumbar plexus nerves that innervate the hip joint capsule estimated as significant motor block of the femoral (L2-L4, knee extension) and obturator (L2-L3, hip adduction) nerves and significant sensory block of the lateral femoral cutaneous nerve (cold or pain). Motor block is a proxy marker for sensory block. |
Blok succes af de klinisk relevante lumbale pleksus nerver, der innerverer hofteledskapslen, estimeret som signifikant motorisk blokade af n. femoralis (L2-L4, knæekstension) og n. obturatorius (L2-L3, hofteadduktion) samt sensorisk blokade af n. cutaneus femoris lateralis (kulde eller smerte). Motorisk blokade er en proksy markør for sensorisk blokade. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Motor block is evaluated 60 minutes after completed block procedure and sensory block is evaluated 70 minutes after completed block procedure. |
Motorisk blokade er evalueret 60 minutter efter blokadeanlæggelsen og sensorisk blokade er evalueret 70 minutter efter blokadeanlæggelsen. |
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E.5.2 | Secondary end point(s) |
• Time for preparation (seconds) from placement of study participant on the bed until end of pre-ultrasoundscanning • Time for block procedure (seconds) from placement of ultrasound transducer on the skin until block needle is pulled out after injection of local anesthetics • Minimal electrical nerve stimulation for release of neuromuscular response • Type of neuromuscular response on electrical nervestimulation • Number of needle proceedings (needle proceeding followed by retraction of block needle and new needle proceeding) • Depth of tip of block needle in reference to injection site in skin (cm) • Distance between injection site in skin to the sagittal midline (cm) • Discomfort during block procedure assessed as on numeric rating scale (NRS 0-10: 0 = no discomfort, 10 = worst possible discomfort) • Middlearterial bloodpressure (MAP) after block procedure in reference to pre-block • Perineural spread of local anaesthetics added contrast estimated on MRI scanning for the spinal nerves L1-S1, the femoral, obturator, lateral femoral cutaneous nerves, and the lumbosacral trunk • Epidural spread of local anaesthetics added contrast defined as confirmed circumferential spread estimated on MRI scanning and reduced or absent cold somatosensation in two consecutive dermatomes bilaterally • Motor block of the femoral, obturator, superior gluteal and sciatic nerves estimated with dynamometer and defined as decrease in muscle strength (mmHg) of knee extension, hip adduction, hip abduction, and knee flexion, respectively, in reference to pre-block test • Success of motor block of the femoral, obturator, superior gluteal and sciatic nerves estimated with dynamometer and defined as significant motor block of knee extension, hip adduction, hip abduction, and knee flexion, respectively, in reference to pre-block test • Sensory block (cold, warmth, touch, pain) of the dermatomes T8-S3 and the lateral femoral cutaneous nerve defined as reduced or absent somatosensation • Cost-effectiveness estimated as extra expense per extra successful nerve block (incremental cost-effectiveness ratio, ICER) • Reproducibility of diffusionweighted MRI scans evaluated for quantitive diffusion measures and evaluation of image quality |
• Forberedelsestid defineret som tiden (sekunder) fra lejring af forsøgsperson til præ-ultralydskanningens slut • Anlæggelsestid defineret som tiden (sekunder) fra placering af ultralydtransduceren på huden til blokadenålen er trukket ud fra huden efter injektion af lokalanalgetikum • Minimal elektrisk nervestimulation for udløsning af neuromuskulært respons angivet i mA • Type of neuromuskulært respons på elektrisk nervestimulation • Antal af nålefremføringer defineret som en nålefremføring efterfulgt af en tilbagetrækning og ny fremføring af blokadenålen • Dybde af nåleindstik defineret som afstanden (cm) fra blokadenålens spids til injektionsstedet i huden • Afstanden (cm) fra indstiksstedet i huden til den sagittale midtlinje • Ubehag under blokadeanlæggelsen estimeret på numeric rating scale (NRS 0-10: 0 = intet ubehag, 10 = værst tænkelige ubehag) • Middelarterielt blodtryk (MAP) after blokadeanlæggelsen sammenlignet med før blokadeanlæggelsen • Perineural spredning af lokalanalgetikum tilsat kontrast vurderet på MR skanning for spinal nerverne L1-S1, n. femoralis, n. obturatorius, n. cutanues femoris lateralis, og truncus lumbosacralis • Epidural spredning af lokalanalgetikum tilsat defineret som circumferentiel spredning på MR skanning og nedsat eller ingen bilateral sensorisk sans for kulde i to konsekutive dermatomer • Motorisk blokade af n. femoralis, n. obturatorius, n. glutealis superior og n. ischiadicus vurderet med dynamometer og defineret som nedsættelse af kraft (mmHg) af henholdsvis knæekstension, hofteadduktion, hofteabduktion, og knæfleksion i forhold til reference undersøgelse før blokade • Succes af motorisk blokade af n. femoralis, n. obturatorius, n. glutealis superior og n. ischiadicus vurderet med dynamometer og defineret som signifikant motorisk blokade af henholdsvis knæekstension, hofteadduktion, hofteabduktion, og knæfleksion i forhold til reference undersøgelse før blokade • Sensorisk blokade (kulde, varme, berøring, smerte) af dermatomerne T8-S3 og n. cutaneus femoris lateralis defineret som nedsat eller ingen sensorisk sans • Cost-effectiveness estimated as extra expense per extra successful nerve block (incremental cost-effectiveness ratio, ICER) • Reproducerbarhed af diffusionsvægtede MR skanning evalueret med kvantitative diffusionsmål og evaluering af billedkvalitet |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
• Time for preparation: 0 min after pre-ultrasoundscanning • Time for block procedure: 0 min after block • Minimal electrical nerve stimulation: before injection of local anesthetics • Type of neuromuscular response: before injection of local anesthetics • Number of needle proceedings: 0 min after block • Depth of block needle: 0 min after block • Distance between injection site and midline: 0 min after block • Discomfort: 0 min after block • MAP: 5 min after block • Perineural spread: 10-40 min after block • Epidural spread: 10-40 min and 70 min after block • Motor block: 60 min after block • Motor block success: 60 min after block • Sensory block: 70 min after block • Cost-effectiveness: 2 months after LVLS • MRI reproducibility: 40-55 min after block |
• Forberedelsestid: 0 min efter præ-ultralydscanning • Anlæggelsestid: 0 min efter blok • Minimal elektrisk nervestimulation: før injektion af lokalanalgetikum • Type of neuromuskulært respons: før injektion af lokalanalgetikum • Antal af nålefremføringer: 0 min efter blokade • Dybde af nåleindstik: 0 min efter blokade • Afstanden mellem indstikssted til midtlinje: 0 min efter blokade • Ubehag: 0 min efter blokadeanlæggelse • MAP: 5 min efter blokade • Perineural spredning: 10-40 min efter blokade • Epidural spredning: 10-40 min og 70 min efter blokade • Motorisk blokade: 60 min efter blokade • Succes af motorisk blokade: 60 min efter blokade • Sensorisk blokade: 70 min efter blokade • Cost-effectiveness: 2 måneder efter LVLS |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Cost-effetiveness (ICER) of the ultrasound/MRI image fusion guided Shamrock method vs. the ultrasound guided Shamrock method. |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | Yes |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
En anden teknik til at placere den samme medicin |
Another technique to place the same medical product |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |