ESPB, Pericapsular Nerve, Quadratus Lumborum, Total Hip Surgery
Conditions
Brief summary
The aim of this study is to compare between Pericapsular Nerve Group Block, Erector Spinae Plane Block and Quadratus Lumborum Block for managing acute postoperative pain in patients undergoing total hip surgeries under spinal anesthesia.
Detailed description
Total hip surgeries are one of the most common major orthopedic procedures to improve patient's functional status and quality of life. However, despite these advantages, the immediate postoperative period can be associated with severe pain that delays mobilization and increases hospital stay and the risk of thromboembolic events. Various methods are used for postoperative pain management. Intravenous opioid agents are among them, but they may cause undesirable side effects, such as respiratory depression, sedation, constipation, allergic reaction, nausea, and vomiting. Thus, alternative techniques are preferred.
Interventions
PROCEDUREPENG block Technique
A linear probe will be used. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and periosteum and between the anterior inferior iliac spine and iliopubic eminence. After a negative aspiration test, 30 ml of bupivacaine 0.25% will be injected in the plane beneath the iliopsoas muscle
PROCEDURELumbar ESPB Technique
Using the out-plane technique, a 22G/80-mm block needle will be advanced until it reached the transverse process. 0.5-1 ml of the prepared local anesthetic solution, 30 ml bupivacaine 0.25% will be administered leading to hydrodissection to confirm the correct location. The needle will be repositioned by pulling back a few millimeters if resistance occurs when administering local anesthetic . All local anesthetic will be administered to this location between the transverse process and the erector spinae muscle
PROCEDURETransmuscular QLB-t block Technique
A convex transducer will be placed in the transverse plane on the flank of the patient cranial to the iliac crest. The 4th lumbar vertebral transverse process, erector spinae muscles, psoas muscle, transverse abdominis muscle, internal and externa oblique muscles, and the quadratus lumborum muscle will be identified. A 15 cm 22G insulated needle will be inserted on the posterior corner of the transducer. 30 ml bupivacaine 0.25% will be administered between the quadratus lumborum and psoas muscles into the fascial plane.
Sponsors
Kafrelsheikh University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-65 years * Both genders * Body mass index \< 40 kg/m\^2 * American Society of Anesthesiologists (ASA) physical status I-III * Posted for total hip surgeries under spinal anesthesia
Exclusion criteria
* The presence of contraindications or allergy to local anesthetic agents * Chronic use of opioids or corticosteroids * Infection at the puncture site * Coagulopathy * Psychiatric disorders (dementia or cognitive impairment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total amount of rescue analgesia | 24 hours postoperatively | Total amount of rescue analgesia in the form of morphine will be recorded |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| First analgesic request | 24 hours Postoperatively | The time to first request of rescue analgesia will be recorded |
| Pain level | 48 hours Postoperatively | Pain level will be evaluated using numeric rating analogue scale (NRS), which ranges from 0 to 10 points, with 0 indicating no pain, 1-3 indicating mild pain, 4-6 indicating moderate pain, and 7-10 indicating severe pain. |
| Adverse events | 48 hours Postoperatively | Adverse events will be recorded (e.g., nausea, vomiting, hypotension and bradycardia) |
Countries
Egypt
Contacts
Primary ContactMohammad F. Algyar, MD
Outcome results
None listed