Pain, Postoperative, Anesthesia, Regional, Hip Surgery, Ultrasound-Guided
Conditions
Keywords
Hip Surgery, Pericapsular Nerve Group Block, Lumbar Erector Spinae Plane Block, Regional Anesthesia, Ultrasound-Guided
Brief summary
The aim of the study is to determine whether the traditional intravenous analgesia technique or the ultrasound-guided pericapsular nerve group block or the unilateral erector spina plane block technique is superior in postoperative analgesia management in the hip operation procedure that requires preoperative and postoperative severe analgesia. In this way, by preventing the health problems that may occur due to the pain of the patients after the operation; to provide benefits for the early mobilization of patients, shortening the hospital stay, reducing the cost and increasing patient satisfaction.
Detailed description
Hip arthroplasty (HA) is one of the most successful orthopedic procedures applied today to improve the patient's functional status and quality of life. In patients with hip pain due to various conditions, HA can relieve pain, restore function, and improve quality of life. In the USA alone, approximately 500,000 HA is performed each year. With the increase in the elderly population, HA surgeries have also increased, but despite the developing methods, a gold standard has not been determined for anesthesia and analgesia methods. Appropriate pain management for surgical patients contributes to early mobilization, shortened hospital stay, reduced cost and increased patient satisfaction, while inadequate treatment of pain has detrimental short- or long-term health effects. Therefore, minimizing postoperative pain has become more important for healthcare providers in recent years. Therefore, postoperative pain control can be achieved with balanced and effective analgesia. For this purpose, various analgesia techniques have been used to prevent postoperative pain. The superiority of the techniques to each other varies according to the type of surgery and the combination of techniques applied. Opioids, which are the most widely used to prevent inadequate pain treatment leading to various comorbidities, cause pharmacodynamic results due to physiological changes and serious side effects due to concomitant diseases in patients. In recent years, peripheral nerve blocks have been used in the management of postoperative pain in hip surgeries. Erector spina plane block and pericapsular nerve group block are the most reliable and proven blocks used in hip operations. The aim of the study is to determine whether traditional intravenous analgesia technique, ultrasound-guided pericapsular nerve group block or unilateral erector spina plane block technique is superior in postoperative analgesia management in hip operation procedure requiring preoperative and postoperative severe analgesia.
Interventions
PROCEDURELumbar Erector Spinae Plane Block
Erector spinae plane block was applied with a 22G/80 mm block needle (Stimuplex A, Braun, Melsungen, Germany) using in-plane technique using a convex USG transducer from the 4th lumbar vertebral level.
PROCEDUREPericapsular Nerve Group Block
Pericapsular nerve group block was performed using a 22G/80 mm block needle (Stimuplex A, Braun, Melsungen, Germany) and a convex USG transducer using an in-plane technique under the iliopsoas muscle in the plane between the iliopsoas tendon and the periosteum and between the anterior inferior iliac spine and the iliopubic eminence.
PROCEDUREno peripheral block
No peripheral block was applied. Standard multimodal analgesia method was applied.
Sponsors
Trakya University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Masking description
Before surgery, patients were given a random number and all data were collected using this number. Group assignments were determined using simple randomization using the closed envelope technique. All data were collected blindly. The blocks were performed by the authors who did not play any role in data collection or analysis.
Intervention model description
This study was designed as a randomized, double-blind, prospective efficacy study.
Eligibility
Sex/Gender
ALL
Age
18 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing elective hip or proximal femoral surgery * 18-89 years old * Patients with the American Society of Anesthesiology physical condition classification score (ASA) I-III
Exclusion criteria
* Patients who do not agree to consent * Patients who requested to be excluded from the study * Patients allergic to local anesthetics * Those with infection at the intervention site * Those who weigh \<30 kg * Those aged \<18 years * Those with an ASA physical condition of 4 or higher * People with dementia or cognitive impairment * Patients with bleeding diathesis pathology * Patients using chronic opioids or corticosteroids * Patients whose surgical procedure takes \<60 minutes or \>180 minutes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numerical Rating Scale (NRS) | postoperative 24 hours score change | NRS was used to assess postoperative pain. The NRS is a segmented numerical version of the visual analog scale (VAS), in which the respondent chooses an integer (0-10 integer) that best reflects the intensity of his pain. It is considered a one-dimensional measure of pain intensity in adults. It is an 11-point numerical scale. It ranges from 0 representing no pain to 10 representing extreme pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Additional Analgesia | postoperative 24 hours additional analgesic drug administration | Analgesic drugs administered in the first 24 hours in addition to the routine multimodal analgesia procedure were recorded. |
| 5-point likert satisfaction scale | postoperative 24th hour | The patient's satisfaction with postoperative pain treatment will be recorded. 5 options; very dissatisfied, dissatisfied, neither dissatisfied or satisfied, satisfied, very satisfied |
Countries
Turkey (Türkiye)
Outcome results
None listed