Intrathecal Morphine, Postoperative Pain, Total Hip Replacement, Ultrasound Guided Supra-inguinal Fascia Iliaca Block
Conditions
Keywords
Total hip replacement, Ultrasound guided supra-inguinal fascia iliaca block, Intrathecal morphine, postoperative pain
Brief summary
Total hip replacement is one of major orthopedic surgery which result in severe postoperative pain especially at first 24 hours. Ultrasound guided regional anesthesia has become a part of multimodal analgesia.Ultrasound guided supra-inguinal fascia iliaca block is a new technique which can consistently cover femoral and lateral femoral cutaneous nerve. And with large volume (40ml), it may cover obturator nerve. This technique already proved to be useful for acute pain control in hip fracture or postoperative control in dynamic hip screw or nail insertion operation. However, it has not been compared with intrathecal morphine for total hip replacement yet.
Detailed description
By using combine ultrasound guided supra-inguinal fascia iliaca block with periarticular infiltration with mutimodal analgesic drugs will have longer duration time to first rescue analgesic drug compared with combine intrathecal morphine with periarticular infiltration with multimodal analgesic drugs.
Interventions
DRUGIntrathecal morphine
0.5% Iso/Hyperbaric bupivacaine 2-3 ml add morphine 0.1 mg for spinal anesthesia
DRUGUltrasound guided supra-inguinal fascia iliaca block
Ultrasound guided supra-inguinal fascia iliaca block with 0.25% bupivacaine 40 ml and 0.5% Iso/Hyperbaric bupivacaine 2-3 ml without spinal morphine for spinal anesthesia
Sponsors
Mahidol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
* elective surgery of primary total hip replacement, body weight ≥40kg and BMI ≤35 kg/m2, competence to consent
Exclusion criteria
* contraindication to regional anesthesia, allergy to study drugs, skin infection at supra-inguinal fascia iliaca injection point, neurological deficit affecting the lower extremities, inability to use patient-controlled analgesia, GFR \<50 mL/min
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to first analgesic request (PCA fentanyl) | 48 hours | Whether ultrasound guided supra-inguinal fascia iliaca block can increase pain free period of patients undergo total hip replacement under spinal block compare with intrathecal morphine or not |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain score | 48 hours | Pain score at rest and on movement rating by numerical rating scale in 48-hr postoperative |
| Amount of rescue analgesic drugs | 48 hours | Amount of PCA fentanyl |
Countries
Thailand
Contacts
Primary ContactPawinee Pangthipampai, M.D.
Outcome results
None listed