Lumbar Erector Spinae Plane Block, Fascia Iliaca Block, Lumbar Plexus Block, Analgesia, Total Hip Arthroplasty
Conditions
Brief summary
This study aims to compare lumbar erector spinae plane block, fascia iliaca block, and lumbar plexus block for postoperative analgesia for hip surgery.
Detailed description
Approximately 500,000 hip arthroplasties are performed each year in the United States. Traditionally, this procedure has been performed under general anesthesia. However, neuraxial and regional anesthesia have become more commonly utilized to aid in postoperative analgesia and reduce the side effects of opioids, namely sedation, nausea, and vomiting. Postoperative pain control has a significant impact on earlier ambulation, initiation of physical therapy, better functional recovery, and overall patient satisfaction. Lumbar erector spinae plane block (LESPB) was reported to lead to effective postoperative analgesia in hip and proximal femoral surgery. The fascia iliaca block (FIB) is an established and effective technique, especially when US guidance and proximal approaches are used. lumbar plexus block (LPB) could be safe because of the targeted somatic nerve block in the psoas region which prevents dispensable sympathetic block even in cardiovascular-compromised patients.
Interventions
Patients will receive lumbar erector spinae plane block at the end of surgery.
OTHERFascia Iliaca Block
Patients will receive fascia iliaca block at the end of surgery.
OTHERLumbar Plexus Block
Patients will receive lumbar plexus block at the end of surgery.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-III. * Undergoing total hip arthroplasty under spinal anesthesia.
Exclusion criteria
* Obesity (Body Mass Index \> 30 kg/m2). * Allergy to any drug used in the study. * Contraindications to spinal anesthesia (such as Thrombocytopenia (platelets \<100,000/mCL) and coagulopathy (INR \>1.4 or insufficient time since stopping systemic anticoagulation)). * Epilepsy. * Psychiatric disease. * Pre-existing neurologic deficits or neuropathies. * Pregnancy. * Pre-existing alcohol/opioid use disorder. * Previously diagnosed with chronic pain.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to the 1st rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia (time from end of block to first dose of morphine administrated) will be recorded. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption in the 1st 24h | 24 hours postoperatively | Rescue analgesia will be provided by patient-controlled analgesia (PCA) with intravenous morphine (no basal rate; bolus 1 mg, lockout 10 minutes, maximum dose 20 mg in 4 h), which will be started if the numeric rating scale (NRS)\> 3. NRS will be assessed at PACU, 4, 8, 16, and 24 h postoperatively. |
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS). NRS (0 represents no pain while 10 represents the worst pain imaginable). NRS will be assessed at PACU, 4, 8, 16, and 24 h postoperatively. |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as Bradycardia, hypotension, postoperative nausea and vomiting (PONV), or any other complication will be recorded. |
Countries
Egypt
Outcome results
None listed