Pain, Postoperative
Conditions
Brief summary
To compare the different analgesic protocols for patients receiving total hip arthroplasty(THA). Patients will divided into 3 groups, which are 1. fascia iliaca compartment block with IV-PCA(patient controlled analgesia), 2. femoral nerve and lateral femoral cutaneous nerve block with IV-PCA, 3. IV-PCA only.
Detailed description
90 patients will be enrolled and randomized to the 3 different groups. 1. Inclusion criteria: Patient undergoing THA: 20-75 years old, ASA I-III, general anesthesia with intubation, fentanyl IV PCA. 2. Exclusion criteria Alcohol/substance abuse Rheumatoid arthritis Severe coagulation disorder(PLT\<80000 or INR \> 1.5) Peripheral neuropathy Allergy to opioids or local anesthetics BMI\>35 3. The outcome followers are blinded to the intervention provided. 4. Outcome parameters: 1. Opioid consumption of IV PCA in first 24 hrs. 2. NSAID consumption 3. NRS of pain, the timings of follow-up should be: pre-block, 30 mins post-block, 60 mins post-block, 2 hours post-block, 24hours post-block 4. sensory block in FN, Obturator Nerve and LFCN 5. First request of supplemental IV analgesia
Interventions
PROCEDUREFascia iliaca compartment block with IV-PCA
1\. Fascia iliaca compartment block: The injection was performed under ultrasound guidance. Surface landmark is identified on the line between anterior superior iliac spine and pubic tubercle. The injection site is at the medial one-third of the line. The needle is threaded medial to lateral and standardization of local anesthetic deposit is in the fascia plane between fascia iliaca and iliacus muscle. Anesthetic regimen: 2% xylocaine 15mL + 0.5% bupivacaine 15mL.
PROCEDUREFemoral nerve block and lateral femoral cutaneous nerve with IV-PCA
1. Femoral nerve block: The injection was performed under ultrasound guidance. Femoral nerve was identified in the femoral neurovascular bundle below or around inguinal ligament. The needle is threaded with lateral to medial approach. Local anesthetics will be deposited around the femoral nerve, the standardization of protocol is that femoral nerve should be lifted off from iliacus muscle. Anesthetic regimen: 2% xylocaine 10mL + 0.5% bupivacaine 10mL. 2. Lateral femoral cutaneous nerve block: The injection was performed under ultrasound guidance. Lateral femoral cutaneous nerve was identified in the fascia plane between sartorius muscle and tensor fascia lata muscle. Anesthetic regimen: 2% xylocaine 5mL + 0.5% bupivacaine 5mL
PROCEDUREIV-PCA
IV-PCA was programmed and provided to the patient for optimize pain control
Sponsors
Taichung Veterans General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* ASA I-III, general anesthesia with intubation. * fentanyl IV PCA
Exclusion criteria
* Alcohol/substance abuse * Rheumatoid arthritis * Severe coagulation disorder(PLT\<80000 or INR \> 1.5) * Peripheral neuropathy * Allergy to opioids or local anesthetics * BMI\>35
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Temporal changes of Pain score | 1. Pre-intervention(which is the time when operation was done and the patient arrive postoperative care unit.) 2. 30 minutes after intervention, 3. 60 minutes after intervention, 4. 120 minutes after intervention, 5. 24 hours after intervention. | Pain score by numerical rating scale from pre-intervention to 24 hours after intervention(the effect of neural blockade seldom lasts more than 24 hours) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opioid consumptions | postoperatively 24 hours | Including IV-PCA and other analgesics |
| Sensory block in femoral nerve, obturator nerve and lateral femoral cutaneous nerve area | 1 hour post-intervention | — |
| NSAID consumptions | 24 hours postoperatively | — |
Countries
Taiwan
Contacts
Primary ContactTsung-Yung Tang, M.D.
Backup ContactChih-Cheng Wu, M.D.
Outcome results
None listed