Lumbar Plexus Block for Postoperative Pain Control After Hip Arthroscopy. A Randomized Controlled Trial

Phase 4

Completed

Brief Summary: The purpose of this study is to determine whether the use of a lumbar plexus block for arthroscopic hip surgery is superior to oral and intravenous opioid pain medications alone in treating pain. In addition, the study will examine whether lumbar plexus blocks reduce the total amount of pain medication needed, and therefore reduce the side effects of these medicines and increase patient satisfaction. It is hypothesized that addition of the lumbar plexus block will significantly reduce patients' postoperative pain.

Recruitment & Eligibility

Inclusion Criteria

American Society of Anesthesiologists (ASA) Class 1-3
Patients aged 18 to 65 years
Patients scheduled for primary, unilateral arthroscopic hip surgery by Dr. Kelly, Dr. Coleman, or Dr. Anil Ranawat
Planned use of neuraxial anesthesia
Body Mass Index less than 35
Ability to follow study protocol

Exclusion Criteria

Chronic opioid use (defined as daily or almost daily use of opioids for >3 months)
Contraindication to combined spinal-epidural anesthesia including but not limited to bleeding disorder, use of clinically relevant anticoagulant or antiplatelet medications, and anatomic abnormalities.
Contraindication to lumbar plexus block including but not limited to bleeding disorder, use of clinically relevant anticoagulant or antiplatelet medications, and anatomic abnormalities.
Infection at the injection site(s)
Allergy to any of the study medications
Contraindication to a short course of NSAIDs (renal failure, intolerance)
ASA Class 4-5
Patient refusal
Patients younger than 18 years old and older than 65
Patients with any known indwelling hardware of the lumbar spine.
Patients with a peripheral neuropathy of the surgical extremity
Non-English speaking patients

Arm && Interventions

Group	Intervention	Description
Lumbar Plexus Blockade + CSE	Lumbar Plexus Blockade	The study group will receive a lumbar plexus blockade with 30 mL of 0.25% bupivacaine with 1:200,000 epinephrine, followed by a combined spinal-epidural.
Control Group	Control	The control group will receive only a combined spinal-epidural.

Primary Outcome Measures

Name	Time	Method
Numeric Rating Scale (NRS) Pain at Rest (0-10) on Day of Surgery Prior to Discharge	Day of surgery prior to discharge	The Numeric Rating Scale was used to ask patients to rate their pain at rest on a scale of 0 to 10, 0 = no pain and 10 = worst pain imaginable.

Secondary Outcome Measures

Name	Time	Method
Readiness to Discharge From Post-Anesthesia Care Unit (PACU)	Day of surgery prior to discharge	Time to readiness for discharge from the PACU. Patients were considered ready for PACU discharge when they met the following criteria: a) Awake, alert, oriented and responsive b) Minimal pain, Numeric Rating Scale \< 5/10 (0 = no pain, 10 = worst imaginable pain) (parenteral \[injected\] medications not required) c) Vital signs stable d) No active bleeding e) Minimal or no nausea f) Not vomiting, tolerating oral intake g) Oxygen saturation \> 94% (or baseline) on room air h) Patient has urinated.
Narcotic Pain Medication Needed	Day of surgery prior to discharge
Incidence of Nausea	Day of surgery prior to discharge	The number of participants with nausea.
Incidence of Vomiting	Day of surgery prior to discharge	The number of participants who vomited.
Requirement of Antiemetic Rescue	Day of surgery prior to discharge	The number of participants who needed medication to treat their nausea and vomiting.
Patient Satisfaction	First 24 hours after surgery	Patient Satisfaction (0-10; 0 = very dissatisfied, 10 = very satisfied)
Quality of Recovery (QoR-40) Physical Comfort Dimension	First 24 hours after surgery	Assessment of Physical Comfort (minimum score = 12, maximum score = 60). Higher values represent a better outcome

Locations (2): New York Presbyterian Hospital
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New York, New York, United States
Hospital for Special Surgery
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New York, New York, United States