Effects of PNB Timing on Postoperative Delirium for Hip Fracture

NCT07856108 | Not Yet Recruiting

• 1 other identifier: PNB Timing & Delirium
• Study Type: observational
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

Hip fracture is a common cause of hospitalization in older adults and is associated with substantial pain and a high risk of delirium. Peripheral nerve blocks (PNBs) can provide effective, opioid-sparing analgesia, but the relationship between the timing of PNB administration after hospital presentation and subsequent delirium is not well established. This prospective, longitudinal, dual-centre pilot study will evaluate the association between the timing of PNB administration and the development and severity of delirium in adults aged 65 years or older admitted with a hip fracture requiring surgical repair and a planned PNB. Approximately 60 patient participants will be enrolled at University Hospital and Victoria Hospital, London Health Sciences Centre. Caregiver participants will also be recruited to provide information on baseline and follow-up cognitive and functional status. Participants will receive standard clinical care; the study will not determine or alter the timing or type of PNB, surgery, analgesia, or other treatment. PNB timing will be classified as early (\<6 hours after hospital presentation), intermediate (6 to 12 hours), or late (\>12 hours). The primary outcome is new-onset delirium during hospitalization, assessed using the 4 A's Test (4AT). Delirium severity will also be evaluated using serial 4AT scores collected during the hospital stay. The investigators hypothesize that earlier PNB administration will be associated with a lower incidence and severity of delirium. Secondary and exploratory outcomes include perioperative opioid consumption, hospital length of stay, 30-day mortality, delirium burden, and functional and caregiver-reported delirium outcomes at 3 months. The study will also assess recruitment feasibility and generate preliminary estimates of delirium incidence and effect size to inform the design and sample-size calculation of a future adequately powered prospective study.

Conditions

Delirium - Postoperative

Keywords

Anesthesia; Delirium; Peripheral nerve block; Hip fracture

Outcome Measures

Primary Outcomes (1)

• Determination of the impact of peripheral nerve block (PNB) timing on the incidence of new-onset delirium in hip fracture patients.

  Early administration of the PNB will be a PNB placed less than 6 hours after presenting to the hospital with a hip fracture. Intermediate administration of PNB would be within 6 to 12 hours, and late administration of PNB would be more than 12 hours after presentation to the hospital with a hip fracture. New-onset delirium is defined as a 4AT score ≥4 occurring after hospital admission or during the hospital stay in a patient who had a 4AT score \<4 at baseline, or a new increase in 4AT score consistent with delirium in a patient without delirium at admission. This will be measured by analyzing the results of the cognitive and delirium testing questionnaires and determining if there is an association between the occurrence of delirium and timing of PNB administration.

  3 months

Secondary Outcomes (5)

• Association between the timing of PNB administration (early versus intermediate versus late) and the severity of delirium in patients with hip fracture.

  3 months

• Determine impact of PNB administration timing on opioid consumption

  3 months

• Duration of hospital stay

  3 months

• Occurrence of mortality at 30 days

  30 days

• Determination of recruitment feasibility

  2 years

Study Arms (1)

Peripheral Nerve Block

Peripheral nerve block administered for hip fracture pain control

Procedure: Peripheral Nerve Block for Hip Fracture

Interventions

Peripheral Nerve Block for Hip Fracture PROCEDURE

Peripheral Nerve Block for Hip Fracture

Peripheral Nerve Block

Eligibility Criteria

• Age: 65 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patient Participants: Patients admitted for hip fractures requiring surgery with the use of a PNB. Caregiver Participants: Caregivers of patients admitted for hip fractures requiring surgery with the use of a PNB.

You may qualify if:

• Patients admitted to for hip fractures requiring surgery with the use of a PNB.
• Age ≥65 years.
• Able to give consent to participate in this project.
• Able to converse in English.
• Able to complete questionnaires assessing the functional physical and mental status of the patient participant.
• Able to converse in English

You may not qualify if:

• Patient refusal to participate in this project.
• Patient with a 4 4AT score on admission
• Unable to give consent.
• Preexisting cognitive impairment preventing delirium assessment, including (but not limited to) advanced dementia.
• \. None

Sponsors & Collaborators

• London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's: lead

Study Sites (1)

London Health Sciences Centre

London, Ontario, N6A 5A5, Canada

Location

Related Publications (11)

• McGinn R, Talarico R, Hamiltoon GM, Ramlogan R, Wijeysundra DN, McCartney CJL, McIsaac DI. Hospital-, anaesthetist-, and patient-level variation in peripheral nerve block utilisation for hip fracture surgery: a population-based cross-sectional study. Br J Anaesth. 2022 Jan;128(1):198-206. doi: 10.1016/j.bja.2021.10.011. Epub 2021 Nov 16.

  PMID: 34794768 BACKGROUND

• Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthop Traumatol. 2009 Sep;10(3):127-33. doi: 10.1007/s10195-009-0062-6. Epub 2009 Aug 19.

  PMID: 19690943 BACKGROUND

• Guay J, Parker MJ, Griffiths R, Kopp S. Peripheral nerve blocks for hip fractures. Cochrane Database Syst Rev. 2017 May 11;5(5):CD001159. doi: 10.1002/14651858.CD001159.pub2.

  PMID: 28494088 BACKGROUND

• Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014 Mar 8;383(9920):911-22. doi: 10.1016/S0140-6736(13)60688-1. Epub 2013 Aug 28.

  PMID: 23992774 BACKGROUND

• American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc. 2015 Jan;63(1):142-50. doi: 10.1111/jgs.13281. Epub 2014 Dec 12.

  PMID: 25495432 BACKGROUND

• Brown CH 4th, LaFlam A, Max L, Wyrobek J, Neufeld KJ, Kebaish KM, Cohen DB, Walston JD, Hogue CW, Riley LH. Delirium After Spine Surgery in Older Adults: Incidence, Risk Factors, and Outcomes. J Am Geriatr Soc. 2016 Oct;64(10):2101-2108. doi: 10.1111/jgs.14434. Epub 2016 Oct 3.

  PMID: 27696373 BACKGROUND

• Xue P, Wu Z, Wang K, Tu C, Wang X. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study. Neuropsychiatr Dis Treat. 2016 Jan 12;12:137-42. doi: 10.2147/NDT.S97249. eCollection 2016.

  PMID: 26834475 BACKGROUND

• Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020 Oct;125(4):492-504. doi: 10.1016/j.bja.2020.06.063. Epub 2020 Aug 11.

  PMID: 32798069 BACKGROUND

• Kosar CM, Tabloski PA, Travison TG, Jones RN, Schmitt EM, Puelle MR, Inloes JB, Saczynski JS, Marcantonio ER, Meagher D, Reid MC, Inouye SK. EFFECT OF PREOPERATIVE PAIN AND DEPRESSIVE SYMPTOMS ON THE DEVELOPMENT OF POSTOPERATIVE DELIRIUM. Lancet Psychiatry. 2014 Nov;1(6):431-436. doi: 10.1016/S2215-0366(14)00006-6.

  PMID: 25642413 BACKGROUND

• Ding X, Gao X, Chen Q, Jiang X, Li Y, Xu J, Qin G, Lu S, Huang D. Preoperative Acute Pain Is Associated with Postoperative Delirium. Pain Med. 2021 Feb 4;22(1):15-21. doi: 10.1093/pm/pnaa314.

  PMID: 33040141 BACKGROUND

• Watne LO, Idland AV, Fekkes D, Raeder J, Frihagen F, Ranhoff AH, Chaudhry FA, Engedal K, Wyller TB, Hassel B. Increased CSF levels of aromatic amino acids in hip fracture patients with delirium suggests higher monoaminergic activity. BMC Geriatr. 2016 Aug 2;16:149. doi: 10.1186/s12877-016-0324-0.

  PMID: 27484129 BACKGROUND

MeSH Terms

Conditions

Emergence Delirium; Delirium; Hip Fractures

Condition Hierarchy (Ancestors)

Confusion; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neurocognitive Disorders; Mental Disorders; Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries

Study Officials

• Abhijit Biswas, MD

  London Health Sciences Centre and Western University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Abhijit Biswas, MD

CONTACT

5196858500; abhijit.biswas@lhsc.on.ca

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Anesthesiologist, Associate Professor

Study Record Dates

• First Submitted: September 27, 2026
• First Posted: October 2, 2026
• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): January 1, 2028
• Study Completion (Estimated): January 1, 2028
• Last Updated: October 2, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)