Deep Iliacus Plane Block, Transmuscular Quadratus Lumborum Block, Postoperative Analgesia, Total Hip Arthroplasty
Conditions
Brief summary
This study aims to compare the analgesic efficacy, opioid consumption, motor function preservation, and quality of recovery of ultrasound-guided deep iliacus plane block (DIPB) and transmuscular quadratus lumborum block (QLB) in patients undergoing total hip arthroplasty (THA).
Detailed description
Total hip arthroplasty (THA) is one of the most commonly performed orthopedic procedures for the treatment of end-stage hip disorders. It is indicated for conditions such as osteoarthritis, rheumatoid arthritis, avascular necrosis, and femoral neck fractures. The quadratus lumborum block (QLB) is an ultrasound-guided fascial plane block that has been increasingly used for analgesia in hip surgery. The deep iliacus plane block (DIPB) is a recently introduced regional anesthesia technique specifically developed for hip analgesia. The block is performed by depositing local anesthetic in the deep fascial plane between the iliacus muscle and the iliac bone.
Interventions
Patients will receive ultrasound-guided deep iliacus plane block (DIPB) using 25 mL of 0.25% bupivacaine.
DRUGQuadratus lumborum block
Patients will receive ultrasound-guided transmuscular quadratus lumborum block (QLB) using 25 mL of 0.25% bupivacaine.
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 Anesthesiologists (ASA) physical status I-III. * Scheduled for elective unilateral total hip arthroplasty (THA) under spinal anesthesia.
Exclusion criteria
* Known allergy to local anesthetics or study medications. * Coagulopathy or anticoagulant therapy contraindicating regional anesthesia. * Infection at the site of injection. * Pre-existing neurological deficits affecting the lower limbs. * Chronic opioid use or opioid dependence. * Severe hepatic, renal, respiratory, or cardiac disease. * Body mass index (BMI) \> 40 kg/m². * Contraindications to spinal anesthesia.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Degree of pain | Each patient will be instructed about postoperative pain assessment with VAS. VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be assessed at post-anesthesia care unit (PACU), 2, 4, 6, 12, and 24 h postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Rescue analgesia of morphine will be given as 3 mg bolus if the Visual Analog Scale (VAS) \> 3 to be repeated after 30 min if pain persists until the VAS \< 4. |
| Time to the 1st rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia will be recorded from the end of block to first dose of morphine administrated. |
| Time for ambulation | 24 hours postoperatively | Time to ambulation: the time interval (in hours) from the end of surgery to the first successful mobilization of the patient, defined as the ability to stand and walk at least 3-5 steps with or without assistance |
| Length of hospital stay | 24 hours postoperatively | Length of hospital stay will be recorded from admission till the discharge from hospital. |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication will be recorded. |
Countries
Egypt
Contacts
CONTACTMohammed S Elsharkawy, MD
Outcome results
None listed