Arthroplasty, Replacement, Hip, Fascia Iliaca Block
Conditions
Keywords
Arthroplasty, Replacement, Hip, Pain, Postoperative, Nerve Block, Anesthesia, Regional, Fascia Iliaca Block, Ultrasound Guided
Brief summary
The purpose of this study is to determine whether ultrasound guided fascia iliaca blocks performed before surgery help to reduce pain after elective total hip replacements.
Detailed description
Total hip arthroplasty is associated with moderate to severe pain in the acute postoperative period, which can increase the risk of postoperative complications such as thromboembolism, myocardial ischemia/infarction, pneumonia, poor wound healing, insomnia, and delirium. Sensory innervation of the hip joint comes from a combination of peripheral nerves, including femoral, obturator, sciatic, superior gluteal, and nerve for the quadratus femoris muscle. Superficial innervation of the skin involved in incision for hip arthroplasty comes from the lateral femoral cutaneous nerve (LFCN). The fascia iliaca block (FIB) was originally described in 1989 using a landmark technique. The ultrasound guided FIB was introduced in recent years, and has been shown to produce a better quality of block than the landmark technique. It appears to consistently block the femoral and LFCN, while being less successful in achieving consistent obturator blockade. The FIB is effective for analgesia for hip fracture injuries in the emergency department. Thus far, there has been limited exploration into the potential use of this block as a tool for postoperative analgesia after elective hip arthroplasty. The potential benefits of this regional block, as with other regional techniques, include better analgesia, less opioid use and associated side effects, and an improved overall patient satisfaction with postoperative recovery.
Interventions
DRUG.2% Ropivacaine
DRUGSaline
PROCEDUREFascia Iliaca Block
Ultrasound-guided regional anesthesia block to the groin area.
Sponsors
Saskatoon Health Region
University of Saskatchewan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists' (ASA) score I, II or III * Scheduled for elective total hip arthroplasty
Exclusion criteria
* Contraindication to regional anesthesia (allergy to local anesthetic, coagulopathy, infection or malignancy in the area) * Neurologic disorder affecting the ability to sense pain * Long term opioid use or chronic pain disorder * History of drug or alcohol abuse * Patient refusal * Pregnancy * Revision procedures * General anesthetic * Psychiatric or mental conditions that may affect assessment of outcomes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative opioid consumption | 12 hours after surgery | Dilaudid will be used for analgesia postoperatively. If there is a contraindication to Dilaudid, another opioid will be ordered for analgesia, and doses will subsequently be converted back to Dilaudid equivalent doses for comparison |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative opioid consumption | 4, 8, and 48 hours after surgery | Dilaudid will be used for analgesia postoperatively. If there is a contraindication to Dilaudid, another opioid will be ordered for analgesia, and doses will subsequently be converted back to Dilaudid equivalent doses for comparison |
| Verbal pain score (static and dynamic) | PACU, 4, 8, 12, 24, and 48 hours after surgery | Pain score 0-10 with 10 being worst possible pain |
| Opioid side effect (nausea/vomiting, pruritus, constipation, urinary retention, sedation) | PACU, 4, 8, 12, 24, and 48 hours after surgery | Presence of each side effect documented as yes or no. Sedation will be assessed by the Ramsay Sedation Scale. |
| Overall patient satisfaction | 48 hours after surgery | Satisfaction rated as: very dissatisfied, dissatisfied, neutral, satisfied, or very satisfied |
Countries
Canada
Outcome results
None listed