Anesthesia, Regional
Conditions
Keywords
hip arthroscopy, femoral articular branch block
Brief summary
Hip arthroscopy surgery can be associated with significant pain. A regional anesthesia technique, the femoral articular branch block (FAB), has recently been proposed to collectively block terminal femoral and accessory obturator nerve branches to the hip joint with a single injection, theoretically blocking most of the innervation relevant to hip arthroscopy while sparing the main femoral nerve branches to the quadriceps muscles. The investigators aim to demonstrate the analgesic benefits of FAB. The investigators hypothesize that FAB will reduce opioid consumption and improve postoperative quality of recovery in patients having hip arthroscopy. This is a randomized, controlled, double-blind study and half the patients will be randomized to receive the femoral articular branch block and the other half of patients will be randomized to receive a placebo block. A comparison of pain will be made between both groups.
Detailed description
Hip arthroscopy is a surgical technique that is gaining popularity for its diagnostic and therapeutic role in the management of adult hip pain. This procedure is frequently associated with severe post-operative pain despite the practice of injecting the hip joint with local anesthetics at the end of the procedure and the use of intraoperative opioids. The ideal analgesic technique that provides adequate pain relief following this procedure has not been established yet. There is evidence to suggest that a femoral nerve block (FNB) may provide clinically meaningful analgesia. The investigators have examined the benefits of FNB both retrospectively and prospectively in hip arthroscopy patients at Women's College Hospital (WCH). Both of our studies suggested modest benefits of the FNB in terms of controlling post-operative pain and reducing opioid consumption. However the majority of patients continued to experience moderate to severe post-operative pain and required significant amounts of opioid analgesics in the Peri-Anesthesia Unit (PAU), despite receiving the FNB. Another regional anesthesia technique, the femoral articular branch block (FAB) has recently been proposed to collectively block the terminal femoral and accessory obturator nerve branches to the hip joint with a single injection, theoretically blocking most of the innervation relevant to hip arthroscopy while sparing the main femoral nerve branches to the quadriceps muscle. The investigators aim to demonstrate the analgesic benefits of FAB.
Interventions
PROCEDUREFemoral Articular Branch Block
Slow injection (3mL aliquots) of local anesthetic solution (20ml of Ropivacaine 0.5%) into the fascia above the iliopsoas muscle (located in the groove between the two bony landmarks - (1)anterior inferior iliac crest and (2)iliopubic eminence).This is done by ultrasound guidance.
PROCEDUREPlacebo Block
Subcutaneous injection of 1ml normal sterile saline
Sponsors
Women's College Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Masking description
The anesthesiologist performing the nerve block will be aware of group allocation; but a separate anesthesiologist providing intra-operative care will remain blinded. The patient and the research staff collecting outcome data will remain blinded until all data are collected.
Intervention model description
Patients will be randomized between one of two treatment groups. The intervention of femoral articular branch block or the control group (non-invasive placebo).
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical classification system, ASA I-III patients * 18 - 60 years of age * Body Mass Index (BMI) \<35 kg/m2
Exclusion criteria
* Pre-existing neurological deficits or peripheral neuropathy in the distribution of femoral, obturator, or lateral cutaneous nerves * Local infection * Contra-indication to regional anesthesia e.g. bleeding diathesis, coagulopathy * Chronic pain disorders * History of using over 30mg of oxycodone or equivalent per day * Contraindication to a component of multi-modal analgesia * Allergy to local anesthesia * History of significant psychiatric conditions that may affect patient assessment * Pregnancy * Inability to provide informed consent * Patient refusal of femoral articular branch block * Revision arthroscopy surgeries
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Analgesic Consumption | 24 hours postoperatively | Postoperative cumulative oral morphine equivalent consumption during the first 24 hours will be the first primary outcome |
| Quality of Life scores | 24 hours postoperatively | Quality of Recovery (QR15) scores at 24 hours will be the second primary outcome. QR15 is a measurement of quality of recovery after surgery and anesthesia that has been psychometrically tested and validated. Reporting of outcome measures on a scale of 0 to 10 (0=None of the time and 10=All of the time). There are a total of 40 items/questions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Analgesic Consumption | Up to 48 hours following surgery | Consumption intra-operatively, total in-hospital postoperative consumption, and time to first analgesic request in the first 24 hours, cumulative oral morphine equivalent |
| Presence of Block-related complications | Up until one month following nerve block | vascular puncture, hematoma formation, intravascular injection, epidural anesthesia-bilateral sensory block Presence/ absence of residual paresthesia or numbness over femoral, obturator, and lateral cutaneous nerves distribution |
| Turn over time | after surgery up to discharge, assessed up to 24 hours | PAU leaving time |
| Patient Satisfaction with Analgesic Technique | One month after surgery | A Patient Diary will be completed to assess overall satisfaction with analgesic technique |
| Demographic Data | Day 1 - first 24 hours | Patient demographics - There is no scale, just questions asked of the participant. |
| Incidence of opioid-related side effects | Up until one month following nerve block | nausea, vomiting, pruritus, sedation |
| Pain Assessment (VAS) | Up to 48 hours post-operatively and at 7-day mark | Visual Analogue Scale(VAS) - Pain:Overall pain assessed at rest and on movement A continuous scale comprised of a 100mm (10cm) horizontal line, anchored by 2 verbal descriptions No Pain to Worst Pain |
Countries
Canada
Outcome results
None listed