Continuous Lumbar Plexus Block With and Without Parasacral Block in Patients Undergoing Total Hip Replacement

Rita Merman10 enrolled

Overview

The purpose of this research study is to evaluate the analgesic efficacy of adding a single shot parasacral (sciatic) nerve block to a continuous lumbar plexus block in patients undergoing total hip replacement.

This prospective study is intended to assess the efficacy of placing a parasacral (sciatic) nerve block in addition to a lumbar plexus block for postoperative analgesia following total hip arthroplasty. Although the placement of a lumbar plexus block alone has become accepted as the standard of care at UPMC for postoperative analgesia following total hip arthroplasty, the addition of a parasacral (sciatic) nerve block may provide the advantage of blocking the superior gluteal nerve and nerve to the quadratus femoris which both supply small articular sensory branches to the posterior hip capsule.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Osteoarthritis of Hip Regional Anesthesia Other Acute Postoperative Pain

Interventions

Continuous Lumbar Plexus BlockPROCEDURE

Lumbar plexus nerve block placement and activation: After subcutaneous infiltration of local anesthetic, 20 mL of Ropivacaine 0.2% will be injected; the catheter will be introduced for 5 cm past the needle tip and secured with steri strips and tegaderm. In PACU, the catheter will be connected to a pump of 0.0625% bupivacaine at 5 - 10 mL per hour at the discretion of the Acute Interventional Perioperative Pain Service (AIPPS). Additional 5mL boluses of 0.0625% bupivacaine will be given on demand once per hour prn.

Parasacral Nerve BlockPROCEDURE

A single shot parasacral (sciatic) nerve block will then be place under the ultrasound guidance. Ropivacaine 0.2% 9 ml will be injected.

Ropivacine 0.2%DRUG

Bupivacaine 0.0625%DRUG

In PACU, the catheter will be connected to a pump of 0.0625% bupivacaine at 5 - 10 mL per hour at the discretion of the Acute Interventional Perioperative Pain Service (AIPPS). Additional 5mL boluses of 0.0625% bupivacaine will be given on demand once per hour prn.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Subject has signed and dated an Informed Consent Form. 2. Subject is classified as a ASA (American Society of Anesthesiologists) status I-III 3. Subject is age 18- 75 years old. 4. Subject is having primary total hip arthroplasty 5. No contraindication to peripheral nerve catheter ( local infection or hypocoagulable state) 6. Patient willing to receive spinal anesthesia as operative anesthesia 7. No known drug allergies to study medications 8. Patients not expected to receive therapeutic anticoagulation in the postoperative period. Exclusion Criteria: 1. Subject inability to provide adequate informed consent. 2. Age younger than 18 years or older than 75 years 3. Any contraindication to the placement of lumbar plexus catheter, including local infection, hypocoagulable state. 4. ASA (American Society of Anesthesiologists) physical status of IV or greater 5. Any chronic painful conditions 6. Preoperative opioid use 7. Coagulation abnormalities or patients who are expected to be on therapeutic anticoagulants postoperatively

Outcomes

Primary Outcomes

Numeric Rating Scale (NRS) Pain Assessment

Postoperative pain assessments using a 11-point numerical rating during physical therapy and at rest. This pain scale ranges from 0, being no pain at all, up to 10 being the worst pain ever experience.

Time frame: 6 hours after the start of surgery

Numeric Rating Scale (NRS) Pain Assessment

Time frame: 24 hours after the start of surgery

Numeric Rating Scale (NRS) Pain Assessment

Time frame: 48 hours after the start of surgery