Lumbar Erector Spinae Plane Block vs Fascia Iliaca Block vs Lumbar Plexus Block for Postoperative Analgesia for Total Hip Arthroplasty

Tanta University90 enrolled

Overview

This study aims to compare lumbar erector spinae plane block, fascia iliaca block, and lumbar plexus block for postoperative analgesia for hip surgery.

Approximately 500,000 hip arthroplasties are performed each year in the United States. Traditionally, this procedure has been performed under general anesthesia. However, neuraxial and regional anesthesia have become more commonly utilized to aid in postoperative analgesia and reduce the side effects of opioids, namely sedation, nausea, and vomiting. Postoperative pain control has a significant impact on earlier ambulation, initiation of physical therapy, better functional recovery, and overall patient satisfaction. Lumbar erector spinae plane block (LESPB) was reported to lead to effective postoperative analgesia in hip and proximal femoral surgery. The fascia iliaca block (FIB) is an established and effective technique, especially when US guidance and proximal approaches are used. lumbar plexus block (LPB) could be safe because of the targeted somatic nerve block in the psoas region which prevents dispensable sympathetic block even in cardiovascular-compromised patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Lumbar Erector Spinae Plane Block Fascia Iliaca Block Lumbar Plexus Block Analgesia Total Hip Arthroplasty

Interventions

Lumbar Erector Spinae Plane BlockOTHER

Patients will receive lumbar erector spinae plane block at the end of surgery.

Fascia Iliaca BlockOTHER

Patients will receive fascia iliaca block at the end of surgery.

Lumbar Plexus BlockOTHER

Patients will receive lumbar plexus block at the end of surgery.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 18 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-III. * Undergoing total hip arthroplasty under spinal anesthesia. Exclusion Criteria: * Obesity (Body Mass Index \> 30 kg/m2). * Allergy to any drug used in the study. * Contraindications to spinal anesthesia (such as Thrombocytopenia (platelets \<100,000/mCL) and coagulopathy (INR \>1.4 or insufficient time since stopping systemic anticoagulation)). * Epilepsy. * Psychiatric disease. * Pre-existing neurologic deficits or neuropathies. * Pregnancy. * Pre-existing alcohol/opioid use disorder. * Previously diagnosed with chronic pain.

Locations (1)

Tanta University

Tanta, El-Gharbia, Egypt

Outcomes

Primary Outcomes

Time to the 1st rescue analgesia

Time to the first request for the rescue analgesia (time from end of block to first dose of morphine administrated) will be recorded.

Time frame: 24 hours postoperatively

Secondary Outcomes

Total morphine consumption in the 1st 24h

Rescue analgesia will be provided by patient-controlled analgesia (PCA) with intravenous morphine (no basal rate; bolus 1 mg, lockout 10 minutes, maximum dose 20 mg in 4 h), which will be started if the numeric rating scale (NRS)\> 3. NRS will be assessed at PACU, 4, 8, 16, and 24 h postoperatively.

Time frame: 24 hours postoperatively

Degree of pain

Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS). NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at PACU, 4, 8, 16, and 24 h postoperatively.

Time frame: 24 hours postoperatively

Incidence of adverse events

Incidence of adverse events such as Bradycardia, hypotension, postoperative nausea and vomiting (PONV), or any other complication will be recorded.

Time frame: 24 hours postoperatively

Data from ClinicalTrials.gov

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