Pain, Postoperative
Conditions
Keywords
Hip Arthroplasty, Erector Spinae Plane Block
Brief summary
The thoracic erector spinae plane (ESP) block was first described by Forero et al in September 2016. In their article, the authors presented the possibility of using this block as an option for the control of thoracic neuropathic pain as well as post-operative thoracic pain. The ESP block is done by administering local anesthetic in the plane deep to the erector spinae muscle, which spreads through the costotransverse foramen to the dorsal and ventral roots of the spinal nerves. Since then, there have been reports about the successful use of this block for bariatric surgery, ventral hernia repair, radical mastectomy, rib fractures, major abdominal surgery and hip replacement. However, there are no studies in the literature comparing the efficacy of the ESP block to other nerve blocks. The purpose of this study is to compare the post-operative analgesic efficacy of the ESP block to the fascia iliaca (FI) block after total hip replacement (THR).
Interventions
PROCEDURESingle-shot erector spinae plane block
Single-shot Erector Spinae Plane block with 30ml of ropivacaine 0,5% + adrenaline 150mcg.
PROCEDURESingle-shot fascia iliaca block
Single-shot Fascia Iliaca block with 40ml of ropivacaine 0,2%
Sponsors
Hospital Beatriz Ângelo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Surgical plan for total hip replacement * Signing of consent form to participate in the study
Exclusion criteria
* Patient refusal * BMI \> 40 kg/m2 * Surgical plan for revision of hip replacement * Patient unable to quantify pain level * Chronic kidney disease with a Glomerular Filtration Rate \< 50ml/min * Previously medicated with opioids * Patient unable to perform the surgery with spinal block * Allergy to local anesthetics * Infection in the site of the Erector Spinae Plane or Fascia Iliaca block * Allergy or contraindication to the use of morphine
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative pain level measured by the Visual Analog Scale | At 6 hours post-operative | Measurement of patient's pain level using the Visual Analog Scale (with a score of 0-100, 0 being no pain and 100 maximum pain) |
| Post-operative pain level measured by morphine consumption using patient-controlled intravenous analgesia | At 24 hours post-operative | Total amount (in mg) of morphine administered by a patient-controlled intravenous analgesia pump of morphine 1mg/ml with bolus of 1ml per patient request with a lockout time of 10 minutes |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensory block assessed through a temperature test | At 24 hours post-operative | Assessment of sensory block through a temperature test and comparison with the contralateral limb (sensory block vs no sensory block) |
| Muscle Strength grade | At 12 hours post-operative | Muscle strength grade and comparison with the contralateral limb in the quadriceps femoris muscle Muscle strength scale: Grade 0: No muscle contraction is detected Grade 1: Muscle contraction is identified but it is insufficient to produce motion Grade 2: The muscle can move the joint only if the force of gravity is eliminated Grade 3: The muscle can move the joint against gravity but without any resistance Grade 4: The muscle can move the joint against moderate resistance Grade 5: The muscle can move the joint against full resistance |
| Sensory block assessed through a tactile stimulation test | At 24 hours post-operative | Assessment of sensory block through a tactile stimulation test and comparison with the contralateral limb (sensory block vs no sensory block) |
| Detection of side effects related to the anesthetic and analgesic technique namely pruritus, urinary retention, nausea and vomiting in each patient | At 24 hours post-operative | Presence of side effects (pruritus, urinary retention, nausea/vomiting) |
Countries
Portugal
Outcome results
None listed