Lower Limb Fracture
Conditions
Brief summary
lumbosacral plexus block (LSPB) has been widely applied in orthopedics departments due to its advantages, including reduction in the application of opiates, decreasing the occurrence of acute pain, promoting early activation, and shortening the time of hospital stay. LSPB is a peripheral regional technique of anesthesia and analgesia, that provides a block of the main components of the lumbosacral plexus.
Detailed description
Traditional ultrasound-guided lumbar plexus block combined with sacral plexus block requires separate blocks at different sites, requiring the lateral decubitus or prone position, which may be suboptimal in patients with severe pain. we present an anterior approach for combined lumbar and sacral plexus blocks with a one-point puncture.
Interventions
PROCEDUREone point combined Lumbar and sacral plexus block
performing an ultrasound-guided one-point combined Lumbar and sacral plexus block using a one-point puncture. Block success will be assessed using the perfusion index (PI) before and after performing the block
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Masking description
Randomization assignments will be kept in sealed envelopes until all preprocedural measurements will be completed
Intervention model description
Using a point puncture approach instead of two punctures to perform lumbosacral plexuses block in the interventional group.
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* ASA I-II. * patients scheduled for unilateral femur or tibial surgery necessitate knee joint intervention * patients who have severe pain hindering changing their position or patients who have spinal fractures or refusing spinal anesthesia. * patients with the capability of communication
Exclusion criteria
* puncture site infection * patients with coagulation disorders * patients who refuse to participate or withdraw due to personal reasons * allergy to local anesthetics. * past surgery at the site of the block * hip ankylosis * drug abuse * Body mass index ≥ 35 kg/m2 * peripheral vascular insufficiency * use of alpha or beta blocker agents * Nerve injury or neuropathy of the affected lower limb * cardiovascular or respiratory decompansation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total intraoperative and postoperative opioid consumption | Total fentanyl used intraoperative and total morphine consumed up to 24 hours postoperative | The total fentanyl doses consumed in the entire operative procedure and morphine consumed for 24 hours postoperative will be calculated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| (NRS) score assessment pre-block, 30 min post-block , and postoperatively in the recovery room, and then it will be repeated 3 h, 6h, 12h, and 24, hours | preoperative and postoperatively pain (NRS) score assessment for 24 hours | Numerical Pain Score (NRS) ranges from 0 to 10, where 0 is no pain, and 10 is the worst pain imaginable. Adequate pain control will be considered at Numerical Pain Score (NRS) \< 4. Pain will be assessed using (the NRS) score preoperatively before the block and 30 min post-block, then postoperatively in the recovery room, 3 h, 6h, 12h, and 24 hours. |
| Block success assessment using perfusion index (PI) before and after performing the block | Recording Perfusion index readings at baseline and 10, 20, 30 min. post block | Perfusion index (PI) values rise with successful peripheral nerve blocks. If PI is not changed, this means block failure |
Countries
Egypt
Outcome results
None listed