Acute Pain, Hip Osteoarthritis, Postoperative Pain, Total Hip Arthroplasty (THA)
Conditions
Keywords
regional anesthesia, quadro-iliac plane block, fascia iliaca block, opioid consumption, quality of recovery
Brief summary
Total hip arthroplasty (THA) causes moderate-to-severe postoperative pain. The PROSPECT guideline recommends the supra-inguinal fascia iliaca compartment block (SI-FICB) for THA, whereas evidence for newer quadratus-lumborum-family blocks is limited. The quadro-iliac plane block (QIPB) is a recently described fascial plane block, and no study has compared QIPB with SI-FICB head-to-head in any surgical context. In this prospective, double-blind, patients undergoing elective THA who receive one of the two routinely used preoperative blocks (SI-FICB or QIPB, chosen by the attending anesthesiologist as part of routine care) are systematically observed and compared. The primary objective is to assess whether the postoperative analgesic efficacy of QIPB is non-inferior to SI-FICB, using the resting NRS pain score at 6 hours postoperatively as the primary endpoint (non-inferiority margin Δ = 1.3).
Interventions
SIFICB is an ultrasound-guided fascial plane block performed via a supra-inguinal approach to the iliac fascia compartment, targeting the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. Single-shot, US-guided, 40 mL 0.25% bupivacaine, before GA induction.
PROCEDUREQuadro-Iliac Plane Block
QIPB is a facial plane block performed under ultrasound guidance with local anesthetic in the interfascial plane between the erector spinae and the quadratus lumborum muscle, at the distal attachment site of the quadratus lumborum muscle on the iliac crest. Single-shot, US-guided, 40 mL 0.25% bupivacaine, before GA induction.
Sponsors
Dokuz Eylul University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18-75 years * Scheduled for elective primary total hip arthroplasty * ASA physical status I-III * Able to understand and communicate in Turkish and complete assessment scales * Completed preoperative anesthesia evaluation and approved for surgery * Signed written informed consent
Exclusion criteria
* Known allergy/contraindication to any local anesthetic, including bupivacaine * Coagulopathy or anticoagulant/antiplatelet therapy contraindicating block (per ASRA 2022) * Active infection or skin breakdown at the block site * Chronic opioid use (≥3 months daily) or history of opioid dependence * Morbid obesity (BMI \> 40 kg/m²) * Cognitive impairment or communication difficulty precluding reliable NRS/QoR-15 assessment * Pregnancy or breastfeeding * Revision THA or emergency THA for fracture * Intraoperative complications requiring major protocol deviation (e.g., \>1000 mL blood loss, cardiac arrest) * Technically failed block (no sensory change at any region on the T1 cold test)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity at rest at 6 hours postoperatively | 6 hours after surgery | Numeric Rating Scale (NRS), 0 = no pain to 10 = worst imaginable pain, measured at rest by a blinded assessor. Non-inferiority margin Δ = 1.3 NRS points. |
Secondary
| Measure | Time frame |
|---|---|
| NRS pain at rest | 0, 2, 4, 6, 12, 24, 48 hours postoperatively |
| NRS pain on movement (active hip flexion) | 0, 2, 4, 6, 12, 24, 48 hours postoperatively |
| Cumulative opioid consumption | 24 hours and 48 hours |
Countries
Turkey (Türkiye)
Contacts
CONTACTOnur Küçük, associate professor
PRINCIPAL_INVESTIGATOROnur Küçük, associate professor
Dokuz Eylul University
Outcome results
None listed