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Ultrasound Guided Blockade of the Lumbar Plexus - the Supra Sacral Parallel Shift

Not Applicable
Completed
Conditions
Hip Fracture
Interventions
Procedure: Lumbar plexus block using LUT technique
Procedure: 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
Inclusion Criteria
  • written informed consent
  • ASA I (American Society of Anesthesiologists physical status classification)
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Exclusion Criteria
  • 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
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
CROSSOVER
Arm && Interventions
GroupInterventionDescription
Lumbar ultrasound trident (LUT)Lumbar plexus block using LUT techniqueLumbar plexus block using LUT technique
Supra Sacral Parallel Shift (SSPS)Lumbar plexus block using SSPS techniqueLumbar plexus block using SSPS technique
Primary Outcome Measures
NameTimeMethod
Success of complete sensory blockade of dermatomes L2, L3, L4, L5, S130 minutes after injection of local anesthetic
Secondary Outcome Measures
NameTimeMethod
Block performance timeFrom start of probe on the skin until injection of local anesthetic is completed
Patient satisfactionImmediately 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 nerve40 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-effectivenessBlock 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 nerve40 minutes after completion of injection of the local anesthetic
Perineural spread of local anesthetic (with contrast) estimated with MRI60 minutes after completion of injection of local anesthetic

Trial Locations

Locations (1)

Department of Anesthesiology, Aarhus University Hospital

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Aarhus, Denmark

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