Hip Fracture
Conditions
Brief summary
Anesthesia for hip surgery can be performed with ultrasound guided blockade of the mesh of nerves (the lumbar plexus) supplying the hip region from the lumbar spinal nerves. This is a relevant technique in patients with severe cardiac comorbidity. The technique is a safer alternative compared to general or spinal anesthesia in these fragile patients. The most recognized technique with ultrasound guidance (Karmakars technique) is technically demanding and based on injection of local anesthetic relatively close to the exit of the spinal nerves from the spine. The risk is spread of local anesthetic to the spinal canal prompting a risk of low blood pressure. This may be fatal in high risk patients. The investigators have developed a simple technique based on injection away from the spinal canal. The investigators expect minimal risk of spread of local anesthetic to the spinal canal with this technique. This randomized, double blinded trial compares the new technique to the established technique of ultrasound guided blockade of the lumbar plexus. The hypothesis is that the new technique has a higher success rate with reduced effect on blood pressure for ultrasound guided lumbar plexus block compared to the established technique.
Interventions
PROCEDURELumbar plexus block using LUT technique
Lumbar plexus block guided by ultrasound and nerve stimulation with the patient in the lateral position and the probe in the parasagittal plane inserting the block needle between the transverse processes of L3 and L4 until an appropriate neuromuscular response is produced.
PROCEDURELumbar plexus block using SSPS technique
Lumbar plexus block guided by ultrasound and loss of resistance (LOR) with the patient in the lateral position and the probe in the parasagittal plane inserting the block needle between the transverse process of L5 and the sacral bone until an appropriate LOR is produced.
Sponsors
University of Aarhus
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* written informed consent * ASA I (American Society of Anesthesiologists physical status classification)
Exclusion criteria
* volunteers who are not able to cooperate * volunteers who do not understand and speak danish * daily use of analgesics * allergy to local analgesics or contrast agents * abuse of medicine or alcohol * volunteers with technical impediments of the planned interventions
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Success of complete sensory blockade of dermatomes L2, L3, L4, L5, S1 | 30 minutes after injection of local anesthetic |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Block performance time | From start of probe on the skin until injection of local anesthetic is completed | — |
| Patient satisfaction | Immediately after completion of injection of local anesthetic | — |
| Mean arterial blood pressure (MAP) | 5 minutes after completion of injection of local anesthetic | Absolute measure and relative change from pre-block measure |
| Cost-effectiveness | Block performance time period | Estimated as incremental cost-effectiveness ratio |
| Plasma lidocaine level (mcg/mL) | 0, 5, 10, 20, 40, 60, and 90 minutes after injection of local anesthetic | Chromatography analysis |
| Sensory blockade of the femoral nerve (cold, warmth, touch, pain) | 30 minutes after completion of injection of local anesthetic | — |
| Motor blockade of the femoral nerve | 40 minutes after completion of injection of the local anesthetic | — |
| Motor blockade of the obturator nerve | 40 minutes after completion of injection of the local anesthetic | — |
| Perineural spread of local anesthetic (with contrast) estimated with MRI | 60 minutes after completion of injection of local anesthetic | — |
| Sensory blockade of each dermatome L1, L2, L3, L4, L5, S1, S2, and S3 (cold, warmth, touch, pain) | 30 minutes after completed injection of local anesthetic | — |
Countries
Denmark
Outcome results
None listed