QIPB vs SI-FICB for Postoperative Analgesia After Total Hip Arthroplasty

N/ANot Yet RecruitingNCT07683663

Dokuz Eylul University84 enrolled

Overview

Total hip arthroplasty (THA) causes moderate-to-severe postoperative pain. The PROSPECT guideline recommends the supra-inguinal fascia iliaca compartment block (SI-FICB) for THA, whereas evidence for newer quadratus-lumborum-family blocks is limited. The quadro-iliac plane block (QIPB) is a recently described fascial plane block, and no study has compared QIPB with SI-FICB head-to-head in any surgical context. In this prospective, double-blind, patients undergoing elective THA who receive one of the two routinely used preoperative blocks (SI-FICB or QIPB, chosen by the attending anesthesiologist as part of routine care) are systematically observed and compared. The primary objective is to assess whether the postoperative analgesic efficacy of QIPB is non-inferior to SI-FICB, using the resting NRS pain score at 6 hours postoperatively as the primary endpoint (non-inferiority margin Δ = 1.3).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

TRIPLE

Enrollment

Conditions

Hip Osteoarthritis Total Hip Arthroplasty (THA)Postoperative Pain

Interventions

Supra-Inguinal Fascia Iliaca Compartment BlockPROCEDURE

SIFICB is an ultrasound-guided fascial plane block performed via a supra-inguinal approach to the iliac fascia compartment, targeting the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. Single-shot, US-guided, 40 mL 0.25% bupivacaine, before GA induction.

Quadro-Iliac Plane BlockPROCEDURE

QIPB is a facial plane block performed under ultrasound guidance with local anesthetic in the interfascial plane between the erector spinae and the quadratus lumborum muscle, at the distal attachment site of the quadratus lumborum muscle on the iliac crest. Single-shot, US-guided, 40 mL 0.25% bupivacaine, before GA induction.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 18-75 years * Scheduled for elective primary total hip arthroplasty * ASA physical status I-III * Able to understand and communicate in Turkish and complete assessment scales * Completed preoperative anesthesia evaluation and approved for surgery * Signed written informed consent Exclusion Criteria: * Known allergy/contraindication to any local anesthetic, including bupivacaine * Coagulopathy or anticoagulant/antiplatelet therapy contraindicating block (per ASRA 2022) * Active infection or skin breakdown at the block site * Chronic opioid use (≥3 months daily) or history of opioid dependence * Morbid obesity (BMI \> 40 kg/m²) * Cognitive impairment or communication difficulty precluding reliable NRS/QoR-15 assessment * Pregnancy or breastfeeding * Revision THA or emergency THA for fracture * Intraoperative complications requiring major protocol deviation (e.g., \>1000 mL blood loss, cardiac arrest) * Technically failed block (no sensory change at any region on the T1 cold test)

Outcomes

Primary Outcomes

Pain intensity at rest at 6 hours postoperatively

Numeric Rating Scale (NRS), 0 = no pain to 10 = worst imaginable pain, measured at rest by a blinded assessor. Non-inferiority margin Δ = 1.3 NRS points.

Time frame: 6 hours after surgery

Secondary Outcomes

NRS pain at rest

Time frame: 0, 2, 4, 6, 12, 24, 48 hours postoperatively

NRS pain on movement (active hip flexion)

Time frame: 0, 2, 4, 6, 12, 24, 48 hours postoperatively

Cumulative opioid consumption

Time frame: 24 hours and 48 hours