Anesthesia, Local, Hip Fractures, Hip Osteoarthritis, Osteonecrosis of Femoral Head
Conditions
Keywords
lumbar plexus block, quadratus lumorum block, total hip arthroplasty, single-needle, shamrock approach
Brief summary
Total hip arthroplasty (THA) is one of the most successful orthopedic procedures to effectively relieve pain and restore function in patients with hip osteoarthritis, osteonecrosis of femoral head and hip fracture.The Lumbar Plexus Block (LPB) is currently used as the standard regional anesthesia technique to provide postoperative pain management after THA. The lumbar plexus (LP) originates from T12 to L5. In general, multiple-needle nerve blockade procedure is needed to block different branches of LP. Therefore, we need more time to finish the regional anethesia procedure and it's not easy for an inexperienced anesthesiologist to master the technique absolutely. In addition, multiple injections will increase the discomfort of the patients. We aim to investigate the effects of lumbar plexus combined with quadratus lumborum block using single-needle technique with Shamrock method as an alternative regional anesthesia.
Interventions
PROCEDUREL3 LPB
ultrasound-guided L3 lumbar plexus block
PROCEDUREL4 LPB
ultrasound-guided L4 lumbar plexus block
PROCEDURET12 block
ultrasound-guided thoracic 12th segment nerve block
PROCEDUREL3 QLB
ultrasound-guided quadratus lumborum block at L3 level
DRUG0.375%ropivacaine 25 ml (Raropin)
0.375%ropivacaine (Raropin) 25ml will be given
DRUG0.375%ropivacaine 40 ml (Raropin)
0.375%ropivacaine (Raropin) 40ml will be given
PROCEDUREGeneral anesthesia with tracheal intubation
General anesthesia with tracheal intubation will be induced with sufentanil, propofol, vecuronium for every patient before the operation and maintained with sevoflurane during the operation
Sponsors
Shanghai 6th People's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Body mass index (BMI) between 18.5 and 30kg/m2 and the weight ≥50kg 2. American Society of Anesthesiologists (ASA) classification I-II 3. Postero-lateral operative incision approach unilateral hip arthroplasty 4. Aged 18-75
Exclusion criteria
1. Patient refusal 2. Patients with coagulopathy or on therapeutic anticoagulation 3. Pregnancy 4. Multiple trauma 5. Hypersensitivity or allergy to ropivacaine 6. History of ankylosing spondylitis or spinal surgery 7. Lower extremity neuropathy 8. Unable to communicate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| sensory block assessment | 30 minutes after nerve block procedure | The sensory block will be assessed by cold alcohol swab and pinprick at lateral, anterior and medial areas of thigh and postero-lateral area of gluteus using a 0 to 2 point scale. 0= no block, patients can feel cold; 1= analgesic block, patient can feel touch but not cold; 2= anesthetic block, patient cannot feel cold or touch. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| postoperative static pain at timepoint 2 | at 6 hours after surgery | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery |
| postoperative static pain at timepoint 3 | at 12 hours after surgery | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery |
| postoperative static pain at timepoint 4 | at 24 hours after surgery | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery |
| postoperative static pain at timepoint 1 | at 30mins after the patient recover from general anesthesia | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery |
| intraoperative sufentanil dosage | during the operation | The total intraoperative sufentanil dosage will be recorded |
| Incidence of block related adverse events | within 24hours after nerve block procedure | Intraoperative and postoperative adverse events such as vascular puncture, local anesthetic systemic toxicity, epidural spread, etc. |
| Cumulative doses of intraoperative vasoactive medications | during the operation | Cumulative doses of intraoperative vasoactive medications (urapidil, atropine, ephedrine and deoxyepinephrine, etc.) |
| Performance time of block | During nerve block procedure | Performance time is defined as the time from insertion of the block needle (skin puncture) until finishing local anaesthetic (LA) injection |
Countries
China
Outcome results
None listed