Pain
Conditions
Keywords
ultrasound, hip, pain
Brief summary
Studies have suggested a link with effective pain relief and reduced illness and death in very unwell patients. This study will determine the most effective method of injecting local anaesthetic around the nerves which supply the hip joint. Local anaesthetic will be injected around the hips nerve supply using either ultrasound, loss of resistance or electrical nerve stimulator to guide the positioning of the needle on patients due for elective total hip replacement. The patient will then be observed for 30 minutes and the patient ability to move or feel the upper leg will recorded. A standard anaesthetic and a hip replacement operation will then be performed. Standard pain relief protocols will be used the operation and after the operation. After the operation we will record the amount of morphine used and how happy the patients have been with their treatment at 6 hours after the operation and at 24 hours after the operation. The first day the patient is able to walk on their new hip replacement will also be recorded.
Interventions
PROCEDUREdetermination of method with highest efficacy (ultrasound or nerve stimulator)
Use of ultrasound to guide the insertion of anterior psoas compartment block
PROCEDUREnerve stimulator
The use of the nerve stimulator to guide insertion of the anterior psoas compartment block
PROCEDUREloss of resistance
Use of ultrasound to guide the insertion of anterior psoas compartment block
Sponsors
Golden Jubilee National Hospital
NHS Greater Glasgow and Clyde
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
35 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Elective primary total hip arthroplasty under general anaesthesia * ASA\<=4 * Able to give informed consent * Able to cooperate with sensory and motor testing of lower limb function
Exclusion criteria
* Abnormal clotting screen (coagulopathy) or thrombocytopenia (\<100,000) * Acute mental test score of \<=7 at any time pre or post operatively * Allergy to local anaesthetic * Signs, symptoms or laboratory evidence of local infection or systemic sepsis * No pre-existing neurological deficit (sensory or motor) affecting lower limb * Patients with lower limb amputations
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| percentage of patients with effective regional analgesia | Induction of anaesthesia |
Secondary
| Measure | Time frame |
|---|---|
| sensory function in lateral cutaneous nerve | 0mins, 10mins 20mins post insertion of local anaesthetic |
| sensory function of femoral nerve | 0mins, 10mins, 20mins after insertion of local anesthetic |
| sensory function of obturator nerve | 0mins, 10mins, 20mins after insertion of local anesthetic |
| motor function of obturator nerve | 0mins, 10mins and 20minutes after insrtion of local anesthetic |
| hospital mortality | 1months after operation |
| acute mental test scores | 6hours and 24 hours post operatively |
| total morphine dose administered | 6hours and 24 hours post operstively |
| day first mobilise post operatively | post operatively 0-10 days |
| patient satisfaction scores | 6 hours and 24hours post operatively |
| motor function of femoral nerve | 0mins,10mins and 20mins post insertion of local anesthetic |
Countries
United Kingdom
Contacts
Primary ContactMalcolm Watson, MBChB, MRCP, FRCA
Outcome results
None listed