Anesthesia
Conditions
Brief summary
The aim of this study is to investigate the efficiency of post-operative analgesia by fascia iliaca compartment block versus pericapsular nerve group block block in reducing narcotic consumption during the first 24 hour post-operatively by using the Visual Analogue Scale.
Detailed description
Total hip arthroplasty is a widely used surgical treatment intervention for treating hip conditions such as femur neck fractures and advanced hip osteoarthritis. Hip fractures are quite common, regardless of the age of the population (young or old), and they are extremely painful. A hip fracture is a serious injury with potentially life-threatening complications, and it is a common orthopedic emergency in elderly individuals. Early surgery within 48 hours of a fracture has been found to lower mortality and complication rates. The pericapsular nerve group block is a novel regional analgesia technique to decrease pain after THA while preserving the motor function. The local anaesthetic is deposited using this method in the fascial plane between the psoas muscle and the superior pubic ramus, which aims sensory branches of the obturator, accessory obturator, and femoral nerves in the anterior capsule of the hip. Fascia iliaca compartment block, for procedures on the femur and hip joint, is still a well-liked regional anaesthetic technique. Studies have found that FICB prevents complications by anaesthetizing the femoral nerve far from critical neurovascular structures while still giving enough analgesia. Both blocks could be used to effectively reduce pain intensity up to 24 hours, total opioid consumption, and length of hospital stay in THA patients.
Interventions
PROCEDUREfascia iliaca compartment block
Block will be performed using an ultrasound machine with a high-frequency linear probe covered with a sterile sheath and 100 mm needle. The patient will be positioned supine to perform the block, the skin is disinfected and the transducer positioned to identify the femoral artery and the iliopsoas muscle and fascia iliaca. The transducer is moved laterally until the sartorius muscle is identified. The in-plane technique will be used, and the tip of the needle will be inserted between the fascia iliaca and iliopsoas muscle. a syringe containing 15ml of 0.25% bupivacaine will be injected.
PROCEDUREpericapsular nerve block
The block will be performed using the curvilinear low-frequency ultrasound probe to be placed over the line parallel to the inguinal ligament then It will be rotated 45◦ to identify the anterior inferior iliac spine, the iliopubic eminence, and the psoas tendon. A 22-gauge, 80 mm echogenic needle will be inserted in an in-plane approach to place the tip in the musculofascial plane between the pubic ramus posteriorly and the psoas tendon anteriorly a syringe containing 15ml of 0.25% bupivacaine will be injected .
PROCEDUREpalcebo fascia iliaca compartment block
Block will be performed using an ultrasound machine with a high-frequency linear probe covered with a sterile sheath and 100 mm needle. The patient will be positioned supine to perform the block, the skin is disinfected and the transducer positioned to identify the femoral artery and the iliopsoas muscle and fascia iliaca. The transducer is moved laterally until the sartorius muscle is identified. The in-plane technique will be used, and the tip of the needle will be inserted between the fascia iliaca and iliopsoas muscle. a syringe containing 15ml of normal saline will be injected.
PROCEDUREpalcebo pericapsular nerve block
The block will be performed using the curvilinear low-frequency ultrasound probe to be placed over the line parallel to the inguinal ligament then It will be rotated 45◦ to identify the anterior inferior iliac spine, the iliopubic eminence, and the psoas tendon. A 22-gauge, 80 mm echogenic needle will be inserted in an in-plane approach to place the tip in the musculofascial plane between the pubic ramus posteriorly and the psoas tendon anteriorly a syringe containing 15ml of normal saline will be injected .
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-80 years. 2. Sex: Both sexes. 3. American Society of Anaesthesiologists (ASA) Physical Status Class I, II, and III. 4. Scheduled for Total hip arthroplasty (THA) under spinal anesthesia.
Exclusion criteria
1. Declining to give a written informed consent. 2. History of allergy to the medications used in the study. 3. Contraindications to regional anesthesia (including patient refusal, coagulopathy, and local infection). 4. Psychiatric disorders. 5. Significant cognitive dysfunction. 6. American Society of Anesthesiologists (ASA) Physical Status Class IV. 7. Liver failure, renal insufficiency (estimated glomerular filtration rate \< 15 mL/min/1.73 m2). 8. Patients who had failed spinal anaesthesia were excluded from the study. 9. Pregnancy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The effect of the studied blocks on the Visual Analogue Scale for pain | Immediately postoperatively (zero time) | the Visual Analogue Scale for pain is ranging from 0 to 10, where 0 is no pain and 10 is maximum pain |
| Change in the Visual Analogue Scale for pain | Every 2 hours during the first 6 hours | the Visual Analogue Scale for pain is ranging from 0 to 10, where 0 is no pain and 10 is maximum pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The total dose of nalbuphine in mg was used postoperatively per patient | 24 hours postoperatively | rescue analgesia |
| Mean arterial blood pressure change | 24 hours postoperatively | hemodynamics |
| Heart rate change | 24 hours postoperatively | hemodynamics |
Countries
Egypt
Contacts
Primary ContactDiaaeldin DA Aboelnile, MD, Lecturer
Outcome results
None listed