Ultrasound Guided Blockade of the Lumbar Plexus - the Supra Sacral Parallel Shift
- Conditions
- Hip Fracture
- Interventions
- Procedure: Lumbar plexus block using LUT techniqueProcedure: Lumbar plexus block using SSPS technique
- Registration Number
- NCT01669018
- Lead Sponsor
- University of Aarhus
- Brief Summary
Anesthesia for hip surgery can be performed with ultrasound guided blockade of the mesh of nerves (the lumbar plexus) supplying the hip region from the lumbar spinal nerves. This is a relevant technique in patients with severe cardiac comorbidity. The technique is a safer alternative compared to general or spinal anesthesia in these fragile patients.
The most recognized technique with ultrasound guidance (Karmakars technique) is technically demanding and based on injection of local anesthetic relatively close to the exit of the spinal nerves from the spine. The risk is spread of local anesthetic to the spinal canal prompting a risk of low blood pressure. This may be fatal in high risk patients.
The investigators have developed a simple technique based on injection away from the spinal canal. The investigators expect minimal risk of spread of local anesthetic to the spinal canal with this technique.
This randomized, double blinded trial compares the new technique to the established technique of ultrasound guided blockade of the lumbar plexus.
The hypothesis is that the new technique has a higher success rate with reduced effect on blood pressure for ultrasound guided lumbar plexus block compared to the established technique.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 20
- written informed consent
- ASA I (American Society of Anesthesiologists physical status classification)
- volunteers who are not able to cooperate
- volunteers who do not understand and speak danish
- daily use of analgesics
- allergy to local analgesics or contrast agents
- abuse of medicine or alcohol
- volunteers with technical impediments of the planned interventions
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Lumbar ultrasound trident (LUT) Lumbar plexus block using LUT technique Lumbar plexus block using LUT technique Supra Sacral Parallel Shift (SSPS) Lumbar plexus block using SSPS technique Lumbar plexus block using SSPS technique
- Primary Outcome Measures
Name Time Method Success of complete sensory blockade of dermatomes L2, L3, L4, L5, S1 30 minutes after injection of local anesthetic
- Secondary Outcome Measures
Name Time Method Block performance time From start of probe on the skin until injection of local anesthetic is completed Patient satisfaction Immediately after completion of injection of local anesthetic Mean arterial blood pressure (MAP) 5 minutes after completion of injection of local anesthetic Absolute measure and relative change from pre-block measure
Sensory blockade of each dermatome L1, L2, L3, L4, L5, S1, S2, and S3 (cold, warmth, touch, pain) 30 minutes after completed injection of local anesthetic Motor blockade of the obturator nerve 40 minutes after completion of injection of the local anesthetic Plasma lidocaine level (mcg/mL) 0, 5, 10, 20, 40, 60, and 90 minutes after injection of local anesthetic Chromatography analysis
Cost-effectiveness Block performance time period Estimated as incremental cost-effectiveness ratio
Sensory blockade of the femoral nerve (cold, warmth, touch, pain) 30 minutes after completion of injection of local anesthetic Motor blockade of the femoral nerve 40 minutes after completion of injection of the local anesthetic Perineural spread of local anesthetic (with contrast) estimated with MRI 60 minutes after completion of injection of local anesthetic
Trial Locations
- Locations (1)
Department of Anesthesiology, Aarhus University Hospital
🇩🇰Aarhus, Denmark