Quadroiliac Plane Block, Transmuscular Quadratus Lumborum Block, Postoperative Analgesia, Total Hip Arthroplasty
Conditions
Brief summary
This study aims to evaluate and compare the postoperative analgesic efficacy, opioid consumption, motor function preservation, and quality of recovery of ultrasound-guided Quadroiliac Plane Block (QIPB) versus transmuscular quadratus lumborum block (QLB) in patients undergoing THA under spinal anesthesia.
Detailed description
Total hip arthroplasty (THA) is a common orthopedic procedure for end-stage hip diseases such as osteoarthritis and avascular necrosis. It is highly effective in relieving pain and restoring function. The quadratus lumborum block (QLB) is one such fascial plane technique. It provides analgesia through spread of local anesthetics within the thoracolumbar fascia. This allows potential involvement of lumbar plexus branches. The Quadroiliac Plane Block (QIPB) is a newer regional technique for hip and pelvic surgery. It targets fascial planes near the iliac region to block sensory innervation of the hip. Early studies suggest it may provide effective postoperative analgesia.
Interventions
Patients will receive an ultrasound-guided Quadroiliac Plane Block (QIPB) using 20 mL of bupivacaine 0.25%.
Patients will receive ultrasound-guided quadratus lumborum block (QLB) (transmuscular approach) using 20 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 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-75 years. * Both sexes. * American Society of Anesthesiologists (ASA) classification I-III. * Scheduled for elective primary unilateral total hip arthroplasty under spinal anesthesia.
Exclusion criteria
* Allergy to local anesthetics. * Infection at the injection site. * Coagulopathy or bleeding disorders. * Neuromuscular disorders. * Chronic opioid use or dependence. * Body mass index (BMI) \> 40 kg/m². * Severe cardiac, hepatic, renal, or respiratory dysfunction. * Contraindication to regional anesthesia.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS) \> 3 to be repeated after 30 min if pain persists until the NRS \< 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at post-anesthesia care unit (PACU), 2, 4, 6, 12, and 24 h postoperatively. |
| Time to the 1st rescue analgesia | 24 hours postoperatively | Time to the first request for 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 | Till the discharge from hospital (Up to 2 weeks) | 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