Anesthesia, Regional, Femoral Articular Branch Block, Hip Arthroplasty
Conditions
Brief summary
Hip arthroplasty 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 arthroplasty. 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 arthroplasty 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. These patients usually receive a spinal anesthetic as well. The ideal analgesic technique that provides adequate pain relief following this procedure has not been established yet. 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
QUADRUPLE (Subject, Caregiver, Investigator, 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 85 Years
Healthy volunteers
No
Inclusion criteria
* ASA I-III patients * Ages 18-60yrs * BMI ≤ 35 kg/m2
Exclusion criteria
* Preexisting 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 use of over 30mg oxycodone or equivalent per day * Contraindication to a component of multi-modal analgesia * Allergy to local anesthetics * History of significant psychiatric conditions that may affect patient assessment * Pregnancy * Inability to provide informed consent * Patient refusal of FAB * 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain Assessment (VAS) | Up to 48 hours post-operatively | 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 |
| 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 |
| Incidence of block-related complications | Up until one month following nerve block | vascular puncture, hematoma formation, intravascular injection, epidural anesthesia-bilateral sensory block |
| Block Success | 4 hours after nerve block has been administered | Sensory and motor block onset assessment in the 3 nerves involved will be performed every 5 minutes post block procedure up until 30 minutes and then one, two, and four hours postoperatively. |
| 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 |
Contacts
CONTACTDidem Bozak
PRINCIPAL_INVESTIGATORRichard Brull, MD
Women's College Hospital
Outcome results
None listed