Quadratus Lumborum Block Versus Fascia Iliaca Block for Hip Arthroplasty
- Conditions
- Post Operative Pain
- Interventions
- Procedure: quadratus lumborum block; (Anterior QLB or QLB III)Procedure: suprainguinal fascia iliaca blockProcedure: Subarachnoid block
- Registration Number
- NCT04005326
- Lead Sponsor
- Bassant M. Abdelhamid
- Brief Summary
Quadratus lumborum block is a newly developed block with good performance in lower abdominal surgery. In a cadaveric study, the spread of local anesthetic in the anterior approach of QL block (QL3) was reported to cover nerve roots from T10 to L3. Thus, it was hypothesized that this approach could be used in hip surgeries with minimal motor affection.
This study aims to compare QL3 block and suprainguinal Fascia Iliaca block in the duration of postoperative analgesia, pain scores, motor power in quadriceps muscle, and side effects.
- Detailed Description
A randomized, controlled, double blinded, trial will be conducted in Cairo university hospital. Written informed consent will be obtained from all participants. Randomization will be achieved using a computer-generated sequence. Concealment will be achieved using opaque envelopes. Patients scheduled for hip replacement surgeries under subarachnoid block (SAB). e.g. hip hemiarthroplasty, total hip arthroplasty.
On arrival of the patients to regional anesthesia room, patients will be secured with 18-gauge intravenous cannula, and will receive ondansetron (4 mg), and dexamethasone (8 mg IV). Monitoring will include Electrocardiography, non-invasive arterial blood pressure, and pulse oximetry.
Before receiving subarachinoid block, patients will be randomly assigned into one of the two study groups:
QLB Group (n=17): this group will receive ultrasound-guided transmuscular quadratus lumborum block; (Anterior QLB or QLB III) FIB Group (n=17): this group will receive suprainguinal fascia iliaca block To achieve double blinding, patients will receive the block with 30 mL bupivacaine (0.25%) by the anesthetist. Another doctor not involved in the block procedure will evaluate the patients postoperative.
After finishing the block \& assessment of motor power of quadriceps femoris muscle , patient will receive midazolam (2mg intravenous), and then transferred to operation room.
Postoperatively, all patients will receive 1 g paracetamol every 6 hours and 30 mg ketorolac every 12 hours.
If the visual analogue scale (VAS) is 4 or more, a 2 mg morphine increment will be added per time to maintain a resting VAS at \<3 with maximum total 24-hours morphine 10 mg.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 34
- Patients scheduled for hip replacement surgeries under subarachnoid block (SAB). e.g. hip hemiarthroplasty, total hip arthroplasty.
- Coagulopathy, infection at the injection site,.
- Allergy to local anesthetics.
- Severe cardiopulmonary disease (≥ASA IV),.
- Diabetic or other neuropathies.
- Patients receiving opioids for chronic analgesic therapy.
- Contraindication to spinal anesthesia.
- Inability to comprehend visual analogue scale (VAS).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description QLB Group quadratus lumborum block; (Anterior QLB or QLB III) this group will receive ultrasound-guided transmuscular quadratus lumborum block; (Anterior QLB or QLB III) QLB Group Subarachnoid block this group will receive ultrasound-guided transmuscular quadratus lumborum block; (Anterior QLB or QLB III) FIB Group suprainguinal fascia iliaca block this group will receive suprainguinal fascia iliaca block FIB Group Subarachnoid block this group will receive suprainguinal fascia iliaca block
- Primary Outcome Measures
Name Time Method Duration of analgesia 24 hours postoperative If the visual analogue scale (VAS) is 4 or more, a 2 mg morphine increment will be added per time to maintain a resting VAS at \<3 with maximum total 24-hours morphine 10 mg.
- Secondary Outcome Measures
Name Time Method Onset of sensory block of quadratus lumborum block and fascia iliaca block 30 minutes the time interval between the injection of the study medication till complete loss of sensation
Time to first postoperative analgesic request 24 hours postoperative morphine increment will be added per time to maintain a resting VAS at \<3 with maximum
Total morphine requirements 24 hours postoperative If the visual analogue scale (VAS) is 4 or more, a 2 mg morphine increment will be added per time to maintain a resting VAS at \<3 with maximum total 24-hours morphine 10 mg.
Assessment of the quadriceps muscle power. 24 hours the patient will be in supine position and the patient's knee will be fully flexed, and the patient will be asked to extend it. The motor block is classified as follows: grade 0; normal muscle power, grade I; motor weakness, grade II; complete motor paralysis
Time needed to perform the block 30 minutes the total time of the procedure (quadratus lumborum block or fascia iliaca block) started from patient positioning till completion of local anesthesia injection.
incidence of pain during positioning for spinal block 30 minutes to assess the ability of either two types of the the blocks to relieve pain during positioning for spinal anesthesia
Static visual analogue pain scale 24 hours postoperative Visual analogue pain scale (VAS) at rest. The pain visual analogue pain scale( VAS) is a continuous scale 10 centimeters (100 mm) in length. The scale is most commonly anchored by "no pain" (score of 0) and "pain as bad as it could be" or "worst imaginable pain" (score of 100 \[100-mm scale\]).
Dynamic visual analogue pain scale 24 hours postoperative Visual analogue pain scale (VAS) on movement. The pain visual analogue pain scale( VAS) is a continuous scale 10 centimeters (100 mm) in length. The scale is most commonly anchored by "no pain" (score of 0) and "pain as bad as it could be" or "worst imaginable pain" (score of 100 \[100-mm scale\]).
Trial Locations
- Locations (1)
Anesthesia Department
🇪🇬Cairo, Egypt