RecruitingNot ApplicableInterventional

Trial of local anaesthetic nerve blocks for hip fracture pain relief in prehospital care, compared to usual care (morphine), given by paramedics

A broken hip is a painful emergency that often affects older adults. Standard pain relief provided by paramedics usually involves strong medicines such as morphine. While morphine helps ease pain, it can cause unwanted side effects like dizziness, confusion, sickness, and breathing problems, which can make recovery harder. This study, called RAPID2, investigates whether a numbing injection called a local anaesthetic nerve block works better when given at the scene of the injury. Specially trained paramedics across parts of England and Wales will provide either this nerve block or standard pain relief to adults with a suspected hip fracture. Researchers want to see if this targeted injection reduces pain more effectively, avoids common side effects, helps people walk again sooner, and offers good value for the NHS. Researchers will follow up on participants' recovery for four months.

At a glance

Status

Recruiting

Phase

Not Applicable

Sponsor

Swansea University

Enrolment target

1,404

Start

01 Oct 2021

Estimated completion

28 Feb 2027

Pain relief of patients with hip fracture in prehospital care

What is this study about?

Hip fractures are very common, especially in older adults, and can have a major impact on health and independence. Getting rapid, effective pain relief right after the injury is essential. Usually, paramedics give strong opioid painkillers, such as morphine, on the journey to hospital. However, morphine does not always control the pain completely and can cause troublesome side effects like drowsiness, sickness, confusion, or breathing difficulties, which can slow down recovery.

Researchers are testing an alternative approach called a local anaesthetic nerve block. Instead of affecting the whole body like morphine, this treatment involves a simple injection near the hip to numb the nerves around the broken bone directly. A smaller initial study showed that paramedics could be trained to carry out this injection safely and reliably before arriving at hospital.

This larger study compares the numbing injection directly with standard pain relief. The team wants to find out if the injection leads to better pain control, shorter hospital stays, fewer complications, and a faster return to everyday activities. They will also look at the costs to see whether this treatment should become standard care across the NHS.

Key takeaways

The trial compares a targeted hip-numbing injection against usual pain medicine (morphine) given by paramedics.
The local injection aims to relieve severe pain while avoiding morphine-related side effects like sickness and confusion.
Paramedics receive specialist training to deliver the nerve block safely at the scene of the injury.
Participation is decided randomly during a 999 emergency response for a suspected broken hip.
Patients are followed up for four months to check on their healing, mobility, and recovery.

Who may be eligible?

This study is designed for adults who have suffered a suspected broken hip following a 999 emergency call. To take part, the patient must be attended by a paramedic who is specially trained in the study, be conscious and able to communicate, have stable vital signs (such as normal heart rate and blood pressure), and be travelling to a participating hospital.

The trial is not suitable for everyone. People cannot take part if they are taking blood-thinning medicines, as these can increase the risk of bleeding around the injection site. It is also not suitable for people who already have an artificial hip joint on the injured side, are showing signs of a stroke, or are attended by a lone paramedic.

Finally, patients who do not wish to receive pain relief or who are too distressed or confused to be assessed safely will receive standard emergency care instead.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

You are an adult who called 999 with a suspected hip fracture.
You are conscious, awake, and able to communicate.
You are NOT taking blood-thinning medications (anticoagulants).
You do NOT have an artificial joint replacement in the injured hip.
You are attended by a trained trial paramedic and travelling to a participating hospital.

Answer every question to see your result.

What does participation involve?

Because this study takes place during an emergency, participation begins immediately when the 999 paramedic arrives. If the patient is eligible, the paramedic uses a random system (similar to flipping a coin) to decide whether to give the local anaesthetic nerve block injection or standard pain relief, such as morphine. Pain levels and vital signs are checked at the scene and on the way to the hospital.

Once at the hospital, standard medical care and surgery continue as normal. After leaving hospital, the research team will check in with the patient or their family at points up to four months following the injury. These check-ins will gather information on how well the hip is healing, mobility, quality of life, and overall satisfaction with care.

Potential risks and benefits

The main potential benefit of taking part is receiving fast, effective pain relief that targets the injured hip directly while avoiding the common side effects of morphine, such as sickness and confusion. The potential risks of the local anaesthetic injection include bruising, pain at the needle site, or, very rarely, infection or temporary nerve irritation. Morphine also has known risks, including shallow breathing and drowsiness. Your safety is always the top priority, and you or your family have the right to opt out of the study follow-up at any time without it affecting your medical care.

Locations (9)

Welsh Ambulance Services
City only
Swansea, Wales
Morriston Hospital
Approximate
Swansea, Wales
East of England Ambulance Service
Approximate
Melbourn, England
James Paget University Hospitals NHS Foundation Trust
City only
Great Yarmouth, England
Isle of Wight NHS Trust
City only
Newport, England
South Central Ambulance Service NHS Foundation Trust
Unverified
Bicester, England
Queen Alexandra Hospital
Unverified
Portsmouth, England
University Hospital Southampton NHS Foundation Trust
Unverified
Southampton, England
Royal Berkshire NHS Foundation Trust
Unverified
Reading, England

Common questions

How is it decided which pain relief I receive?

A computerised random selection process is used, similar to flipping a coin. This ensures a fair and unbiased comparison between the two treatments.

Is the numbing injection safe when given by a paramedic?

Yes. Paramedics taking part receive dedicated hospital training to deliver the injection safely, following positive safety results in an earlier trial.

Will taking part delay my journey to hospital?

No. The procedure is designed to be carried out quickly at the scene so that emergency transport to the hospital is not delayed.

Will my hospital surgery or treatment change?

No. Once you arrive at the hospital, you will receive the exact same surgical, medical, and nursing care as any other patient.

Can I leave the study if I change my mind?

Yes. You or your family can choose to stop taking part in the follow-up surveys at any point without giving a reason, and your NHS care will remain unchanged.

How to find out more

Mark Kingston

m.r.kingston@swansea.ac.uk +44 (0)1792 606844 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.