Erector Spinae vs Fascia Iliaca Block in Hip Arthroplasty

Hospital Beatriz Ângelo

Overview

The thoracic erector spinae plane (ESP) block was first described by Forero et al in September 2016. In their article, the authors presented the possibility of using this block as an option for the control of thoracic neuropathic pain as well as post-operative thoracic pain. The ESP block is done by administering local anesthetic in the plane deep to the erector spinae muscle, which spreads through the costotransverse foramen to the dorsal and ventral roots of the spinal nerves. Since then, there have been reports about the successful use of this block for bariatric surgery, ventral hernia repair, radical mastectomy, rib fractures, major abdominal surgery and hip replacement. However, there are no studies in the literature comparing the efficacy of the ESP block to other nerve blocks. The purpose of this study is to compare the post-operative analgesic efficacy of the ESP block to the fascia iliaca (FI) block after total hip replacement (THR).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Conditions

Pain, Postoperative

Interventions

Single-shot erector spinae plane blockPROCEDURE

Single-shot Erector Spinae Plane block with 30ml of ropivacaine 0,5% + adrenaline 150mcg.

Single-shot fascia iliaca blockPROCEDURE

Single-shot Fascia Iliaca block with 40ml of ropivacaine 0,2%

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Surgical plan for total hip replacement * Signing of consent form to participate in the study Exclusion Criteria: * Patient refusal * BMI \> 40 kg/m2 * Surgical plan for revision of hip replacement * Patient unable to quantify pain level * Chronic kidney disease with a Glomerular Filtration Rate \< 50ml/min * Previously medicated with opioids * Patient unable to perform the surgery with spinal block * Allergy to local anesthetics * Infection in the site of the Erector Spinae Plane or Fascia Iliaca block * Allergy or contraindication to the use of morphine

Locations (1)

Hospital Beatriz Ângelo

Loures, Lisbon District, Portugal

Outcomes

Primary Outcomes

Post-operative pain level measured by the Visual Analog Scale

Measurement of patient's pain level using the Visual Analog Scale (with a score of 0-100, 0 being no pain and 100 maximum pain)

Time frame: At 6 hours post-operative

Post-operative pain level measured by the Visual Analog Scale

Measurement of patient's pain level using the Visual Analog Scale (with a score of 0-100, 0 being no pain and 100 maximum pain)

Time frame: At 12 hours post-operative

Post-operative pain level measured by the Visual Analog Scale

Measurement of patient's pain level using the Visual Analog Scale (with a score of 0-100, 0 being no pain and 100 maximum pain)

Time frame: At 24 hours post-operative

Post-operative pain level measured by morphine consumption using patient-controlled intravenous analgesia

Total amount (in mg) of morphine administered by a patient-controlled intravenous analgesia pump of morphine 1mg/ml with bolus of 1ml per patient request with a lockout time of 10 minutes

Time frame: At 24 hours post-operative

Secondary Outcomes

Muscle Strength grade

Muscle strength grade and comparison with the contralateral limb in the quadriceps femoris muscle Muscle strength scale: Grade 0: No muscle contraction is detected Grade 1: Muscle contraction is identified but it is insufficient to produce motion Grade 2: The muscle can move the joint only if the force of gravity is eliminated Grade 3: The muscle can move the joint against gravity but without any resistance Grade 4: The muscle can move the joint against moderate resistance Grade 5: The muscle can move the joint against full resistance

Time frame: At 12 hours post-operative

Data from ClinicalTrials.gov

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