QLESP Block in Hip Surgery

Not Applicable

Withdrawn

• Conditions: Postoperative Pain
• Interventions: Procedure: transmuscular quadratus lumborum and modified erector spinae plane (QLESP) block; Procedure: suprainguinal fascia iliaca block

• Registration Number: NCT05998954
• Lead Sponsor: Huazhong University of Science and Technology

Brief Summary

Total hip arthroplasty (THA) is a common surgical procedure aiming to improve mobility and quality of life in patients suffering from hip pain. Regional analgesia techniques are critical components of an optimal multimodal analgesia technique for THA, as they have been shown to improve pain relief as well as reduce opioid requirements. Ultrasound-guided suprainguinal fascia iliaca (SFI) block has been recommended as a reliable analgesic option for THA. However, SFI block may lead to decreased motor strength of the surgical limb thereby hindering postoperative mobilization. Recently, our group has developed a novel transmuscular quadratus lumborum and modified erector spinae plane (QLESP) block, which is characterized by simple operation, high efficiency, and wide dermatomal coverage of sensory block. In this randomized trial, we aimed to compare ultrasound-guided QLESP with SFI block as a component of non-opioid analgesic regimen in patients undergoing THA. The primary outcome of the study was postoperative sufentanil consumption within the initial 24-h postoperative period after THA. The secondary objectives were to compare pain scores, postoperative quadriceps strength, the time to first rescue analgesia, opioid-related adverse effects, time to ambulation, and the time to hospital discharge.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2023-08-13
• Study First Submitted QC: 2023-08-17
• Study First Posted: 2023-08-21
• Study Start: 2023-08-22
• Status Verified: 2023-11
• Last Update Submitted: 2023-11-06
• Last Update Posted: 2023-11-07
• Primary Completion: 2024-08-20
• Study Completion: 2024-10-20

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

• 1. Age 18-65 yrs 2. American Society of Anesthesiologists classification 1-3 3. Body mass index between 20 and 35 (kg/m2) 4. Undergo elective primary unilateral THA via a posterolateral approach 5. Informed consent

Exclusion Criteria

• 1. A known allergy to the drugs being used 2. Pre-existing neuropsychiatric disorders or language barrier 3. Analgesics intake, history of substance abuse 4. Contraindications to peripheral nerve block 5. Acute cerebrovascular disease 6. Severe liver failure

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Transmuscular quadratus lumborum and modified erector spinae plane (QLESP) block (QLESP group)	transmuscular quadratus lumborum and modified erector spinae plane (QLESP) block	The patient was turned to the lateral decubitus position with the side to be blocked upward and a low-frequency curved array transducer was placed on the flank cranially to the iliac crest to identify the transverse process of L4, quadratus lumborum muscle, erector spinae muscle, and psoas muscle. The needle was advanced to gently contact the transverse process using an in-plane technique and 15 ml of 0.375% ropivacaine was administered between the erector spinae muscle and the transverse process. The needle was subsequently withdrawn and redirected toward the interfascial plane between the quadratus lumborum and the psoas major muscles, where 15 ml of 0.375% ropivacaine was injected with repeated negative aspiration.
Suprainguinal fascia iliaca block (SFI group)	suprainguinal fascia iliaca block	With the patient in the supine position, the ultrasound transducer was placed in a parasagittal orientation over the inguinal ligament, inferior medially to the anterior superior iliac spine. Using real-time ultrasound imaging internal oblique, sartorius and iliacus muscles, covered by the fascia iliacus, were identified. With the needle tip placed beneath the fascia and above the iliacus muscle from caudad-to-cephalad direction (in-plane technique), 30 ml of 0.375% ropivacaine was injected slowly to separate the fascia iliaca from the iliacus muscle.

Primary Outcome Measures

Name	Time	Method
The cumulative opioid consumption	At 24 postoperative hours

Secondary Outcome Measures

Name	Time	Method
The time to first rescue analgesia	Within postoperative 48 hours
Quadriceps strength	At 1, 6, 12, 24, and 48 hours after the surgery
Postoperative hospital length of stay	Up to 6 weeks
Adverse events	Postoperative 48 hours
The pain scores determined by the numeric rating scale (NRS, 0-10)	At 1, 6, 12, 24, and 48 hours after the surgery
The Time to Ambulation	Postoperative 48 hours

Trial Locations

Locations (1)

Wuhan Union Hospital; 🇨🇳 Wuhan, Hubei, China