LPB Combined with QLB Using Single-needle Technique (LPQLB-SNT) for Hip Arthroplasty

Shanghai 6th People's Hospital84 enrolled

Overview

Total hip arthroplasty (THA) is one of the most successful orthopedic procedures to effectively relieve pain and restore function in patients with hip osteoarthritis, osteonecrosis of femoral head and hip fracture.The Lumbar Plexus Block (LPB) is currently used as the standard regional anesthesia technique to provide postoperative pain management after THA. The lumbar plexus (LP) originates from T12 to L5. In general, multiple-needle nerve blockade procedure is needed to block different branches of LP. Therefore, we need more time to finish the regional anethesia procedure and it's not easy for an inexperienced anesthesiologist to master the technique absolutely. In addition, multiple injections will increase the discomfort of the patients. We aim to investigate the effects of lumbar plexus combined with quadratus lumborum block using single-needle technique with Shamrock method as an alternative regional anesthesia.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Hip Osteoarthritis Anesthesia, Local Hip Fractures

Interventions

L3 LPBPROCEDURE

ultrasound-guided L3 lumbar plexus block

L4 LPBPROCEDURE

ultrasound-guided L4 lumbar plexus block

T12 blockPROCEDURE

ultrasound-guided thoracic 12th segment nerve block

L3 QLBPROCEDURE

ultrasound-guided quadratus lumborum block at L3 level

0.375%ropivacaine 25 ml (Raropin)DRUG

0.375%ropivacaine (Raropin) 25ml will be given

0.375%ropivacaine 40 ml (Raropin)DRUG

0.375%ropivacaine (Raropin) 40ml will be given

General anesthesia with tracheal intubationPROCEDURE

General anesthesia with tracheal intubation will be induced with sufentanil, propofol, vecuronium for every patient before the operation and maintained with sevoflurane during the operation

Outcomes

Primary Outcomes

sensory block assessment

The sensory block will be assessed by cold alcohol swab and pinprick at lateral, anterior and medial areas of thigh and postero-lateral area of gluteus using a 0 to 2 point scale. 0= no block, patients can feel cold; 1= analgesic block, patient can feel touch but not cold; 2= anesthetic block, patient cannot feel cold or touch.

Time frame: 30 minutes after nerve block procedure

Secondary Outcomes

postoperative static pain at timepoint 1

Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery

Time frame: at 30mins after the patient recover from general anesthesia

postoperative static pain at timepoint 2

Time frame: at 6 hours after surgery

postoperative static pain at timepoint 3

Time frame: at 12 hours after surgery

postoperative static pain at timepoint 4

Time frame: at 24 hours after surgery

Performance time of block

Performance time is defined as the time from insertion of the block needle (skin puncture) until finishing local anaesthetic (LA) injection

Time frame: During nerve block procedure

intraoperative sufentanil dosage

The total intraoperative sufentanil dosage will be recorded

Time frame: during the operation

Incidence of block related adverse events

Intraoperative and postoperative adverse events such as vascular puncture, local anesthetic systemic toxicity, epidural spread, etc.

Time frame: within 24hours after nerve block procedure

Cumulative doses of intraoperative vasoactive medications

Cumulative doses of intraoperative vasoactive medications (urapidil, atropine, ephedrine and deoxyepinephrine, etc.)