Hip arthroplasty surgery can be associated with significant pain. A regional anesthesia technique, the femoral articular branch block (FAB), has recently been proposed to collectively block terminal femoral and accessory obturator nerve branches to the hip joint with a single injection, theoretically blocking most of the innervation relevant to hip arthroscopy while sparing the main femoral nerve branches to the quadriceps muscles. The investigators aim to demonstrate the analgesic benefits of FAB. The investigators hypothesize that FAB will reduce opioid consumption and improve postoperative quality of recovery in patients having hip arthroplasty. This is a randomized, controlled, double-blind study and half the patients will be randomized to receive the femoral articular branch block and the other half of patients will be randomized to receive a placebo block. A comparison of pain will be made between both groups.
Hip arthroplasty procedure is frequently associated with severe post-operative pain despite the practice of injecting the hip joint with local anesthetics at the end of the procedure and the use of intraoperative opioids. These patients usually receive a spinal anesthetic as well. The ideal analgesic technique that provides adequate pain relief following this procedure has not been established yet. The femoral articular branch block (FAB) has recently been proposed to collectively block the terminal femoral and accessory obturator nerve branches to the hip joint with a single injection, theoretically blocking most of the innervation relevant to hip arthroscopy while sparing the main femoral nerve branches to the quadriceps muscle. The investigators aim to demonstrate the analgesic benefits of FAB.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
95
Slow injection (3mL aliquots) of local anesthetic solution (20ml of Ropivacaine 0.5%) into the fascia above the iliopsoas muscle (located in the groove between the two bony landmarks - (1)anterior inferior iliac crest and (2)iliopubic eminence).This is done by ultrasound guidance.
Subcutaneous injection of 1ml normal sterile saline
Analgesic Consumption
Postoperative cumulative oral morphine equivalent consumption during the first 24 hours will be the first primary outcome
Time frame: 24 hours postoperatively
Quality of Life scores
Quality of Recovery (QR15) scores at 24 hours will be the second primary outcome.
Time frame: 24 hours postoperatively
Pain Assessment (VAS)
Visual Analogue Scale(VAS) - Pain:Overall pain assessed at rest and on movement A continuous scale comprised of a 100mm (10cm) horizontal line, anchored by 2 verbal descriptions No Pain to Worst Pain
Time frame: Up to 48 hours post-operatively
Analgesic Consumption
Consumption intra-operatively, total in-hospital postoperative consumption, and time to first analgesic request in the first 24 hours, cumulative oral morphine equivalent
Time frame: Up to 48 hours following surgery
Incidence of block-related complications
vascular puncture, hematoma formation, intravascular injection, epidural anesthesia-bilateral sensory block
Time frame: Up until one month following nerve block
Block Success
Sensory and motor block onset assessment in the 3 nerves involved will be performed every 5 minutes post block procedure up until 30 minutes and then one, two, and four hours postoperatively.
Time frame: 4 hours after nerve block has been administered
Patient Satisfaction with Analgesic Technique
A Patient Diary will be completed to assess overall satisfaction with analgesic technique
Time frame: One month after surgery
Demographic Data
Patient demographics - There is no scale, just questions asked of the participant.
Time frame: Day 1 - first 24 hours
Incidence of opioid-related side effects
nausea, vomiting, pruritus, sedation
Time frame: Up until one month following nerve block
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